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Case 263.

Jason L Martin1, Paraskevi A Vlachou1

  • 1From the Department of Medical Imaging, Diagnostic Radiology Residency Program, University of Toronto, 263 McCaul St, 4th Floor, Toronto, ON, Canada M5T 1W7 (J.L.M.); and Department of Radiology, St. Michael's Hospital, Toronto, Canada (J.L.M., P.A.V.).

Radiology
|October 18, 2018
PubMed
Summary

This case study highlights a 58-year-old woman with persistent bilateral wrist and knee pain. Despite standard treatments, her inflammatory markers were negative, suggesting an unusual etiology for her joint pain.

Area of Science:

  • Rheumatology
  • Orthopedics
  • Radiology

Background:

  • A 58-year-old woman presented with chronic bilateral wrist and knee pain.
  • Previous treatments including physiotherapy and intra-articular steroid injections were ineffective.
  • The patient had a history of a remote tibia fracture and immigration from Malaysia.

Purpose of the Study:

  • To investigate the cause of refractory bilateral wrist and knee pain in a patient with negative inflammatory markers.
  • To utilize radiographic imaging to aid in diagnosis.

Main Methods:

  • Clinical evaluation in a rheumatology clinic.
  • Review of patient history, including remote trauma and immigration.
  • Radiographic imaging of hands and knees.

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Main Results:

  • Serologic work-up for inflammatory and autoimmune diseases was negative.
  • Radiographs of the hands and knees were obtained for further assessment (Figs 1-4).

Conclusions:

  • The diagnostic process for persistent joint pain requires consideration of non-inflammatory and potentially trauma-related etiologies.
  • Radiographic findings are crucial in evaluating patients with unexplained musculoskeletal symptoms.