Xanthomatosis in bilateral hands mimicking rheumatoid arthritis

Abstract

Rationale:Xanthomatosis often accompanies familial hypercholesterolemia. This disease usually occurs in tendons, most commonly located in the Achilles tendon; occasionally it can also be seen in other systems. Although there are previous reports for bilateral hand extensor tendon involvement, to our knowledge there is no report in English literature regarding bilateral hands with small joint synovium presenting as rheumatoid arthritis. Therefore, the case that is presented in this report is unique.Patient concerns:An 18-year-old woman was admitted to our department because she presented with morning stiffness, joint deformation, and swelling in both hands. Computed tomography of the right hand showed soft tissue swelling on multiple small joints, including metacarpophalangeal and proximal interphalangeal joints, but without obvious bone destruction. There was soft tissue swelling around the small joints, which were hypointensities on T1-weighted and hyperintensities on T2-weighted images, not uniformly enhanced appearances on magnetic resonance imaging.Diagnoses:Biopsy from the 3rd metacarpophalangeal joint capsule of the left hand confirmed xanthoma.Interventions:She was treated with statin drugs to reduce blood fat.Outcomes:After 3 months of follow-up, no recurrence or complications were detected regarding a full range of motion remaining of the affected joints.Lessons:The young patient with symptoms of small joint synovium involved in both hands and the performance of magnetic resonance imaging similar to rheumatoid arthritis may be suffering from xanthomatosis.

Seropositive rheumatoid arthritis in a patient with familial hypercholesterolemia: case report and literature Review

“…Homozygous FH is a very rare disease with a poor prognosis, but heterozygous FH is a relatively common disorder, affecting about 0.2% in most countries [2]. FH may be misdiagnosed as RA because of swelling in the joints and periarticular area and can mimic arthritis or rheumatoid nodules, but despite treatment for RA, the swellings can increase in size [3,4]. Herein, we report a patient with FH presenting with seropositive rheumatoid arthritis.…”

Cholesterol: An Important Determinant of Muscle Atrophy in Astronauts

“…Cholesterol deposits were found in extensor tendons of the hands in hypercholesterolemia patients [ 41 , 42 ]. This could possibly increase the risk of astronauts developing hypercholesterolemia-induced arthritis [ 43 ]. Efforts are underway to improve pressurized gloves to mitigate hand injury, such as the next-generation high performance EVA gloves and the second-generation Space Suit Robot Glove (SSRG) [ 44 , 45 ].…”

Knuckle lesions in inherited and acquired disorders

“…Eruptive xanthomata is associated with hypertriglyceridemia due to uncontrolled type II diabetes, chronic renal failure and associated with systemic retinoid, oral contraceptives and steroids therapy. [ 45 47 48 49 50 51 ]…”