Title:Severe Acro-osteolysis Mimicking Arthritis Mutilans in a Patient with
Primary Hyperparathyroidism: A Case Report
Volume: 20
Issue: 5
Author(s): Tanya Sapundzhieva*, Lyubomir Sapundzhiev, Kamen Klinkanov, Martin Mitev and Anastas Batalov
Affiliation:
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital ‘Pulmed’, Plovdiv, Bulgaria
Keywords:
Hyperparathyroidism, acro-osteolysis, arthritis mutilans, mutilating arthritis, parathormone, osteogenic synovitis.
Abstract:
Background: Primary hyperparathyroidism (PHPT) should be considered in the differential
diagnosis of a patient with suspected secondary osteoporosis, and severe osteoporosis with
multiple fractures is frequently the first clinical manifestation of the disease.
Case Presentation: Mutilating arthritis (arthritis mutilans) can be part of the clinical presentation
of a number of rheumatic diseases, most commonly seen in psoriatic arthritis, rheumatoid arthritis,
and juvenile idiopathic arthritis, but also in systemic lupus, systemic sclerosis, and multicentric
reticulohistiocytosis. Evidence exists that subperiosteal and subchondral bone resorption, seen in
PHPT, could induce the so-called ‘osteogenic synovitis’, which could eventually lead to the development
of a secondary osteoarthritis with bone deformities.
Conclusion: Here, we present a case report of a patient initially diagnosed with PHPT who presented
with mutilating arthritis of the finger joints and discuss whether the severe acro-osteolysis
is a manifestation of the endocrinopathy or whether there is a co-existing undiagnosed inflammatory
joint disease.
