Index to Chiropractic Literature
Index to Chiropractic Literature
My ICL     Sign In
Saturday, July 31, 2021
Index to Chiropractic LiteratureIndex to Chiropractic LiteratureIndex to Chiropractic Literature

For best results switch to Advanced Search.
Article Detail
Return to Search Results
ID 26560
  Title Radiographically occult manifestation of rheumatoid arthritis in a patient with prolonged clinical and laboratory evidence of rampant disease: A case report
Journal J Chiropr Med. 2020 Jun;19(2):128-135
Peer Review Yes
Publication Type Case Report

Objective: The purpose of this case report is to present a case of rampant rheumatoid synovitis and arthritis of a patient with a long duration of symptoms and no radiographic abnormalities of rheumatoid arthritis at the initial diagnosis.

Clinical Features: A 49-year-old Hispanic woman presented to a chiropractic teaching clinic with an 8-month history of bilateral, symmetrical hand pain and stiffness noted specifically in her second and third metacarpophalangeal joints. The patient has reported no other health changes and no history of rheumatoid arthritis in the family.

Intervention and Outcome: Based on this patient's complaint, initial bilateral 3-view radiographic examination of the hands using computed radiography was performed. Despite prolonged history of inflammatory joint pain and rheumatoid arthritis confirmed by abnormally high levels of rheumatoid factor, C-reactive protein, and anti-cyclic citrulline peptide antibodies, the patient had no radiographic evidence of rheumatoid arthritis during the initial and repeat radiographic studies.

Conclusion: Some patients with rheumatoid arthritis may present with rampant clinical and laboratory abnormalities despite an apparent lack of radiographically detectable rheumatoid arthritis. This case demonstrates that astute clinicians should primarily rely on the results of clinical and laboratory abnormalities of rheumatoid arthritis and not be deterred or mislead by an apparent lack of radiographic changes at diagnosis. If the diagnosis of rheumatoid arthritis requires diagnostic imaging confirmation, then magnetic resonance imaging or diagnostic ultrasound of the hands should be used, especially if the initial radiographic assessment remains unrewarding.

Author keywords: Arthritis, Rheumatoid; Rheumatoid Factor; Delayed Diagnosis

Author affiliations: Diagnostic Imaging Department, Clinical Sciences Department, National University of Health Sciences, Lombard, Illinois, United States

This abstract is reproduced with the permission of the publisher; click on the above link for free full text. PubMed Record | PDF


   Text (Citation) Tagged (Export) Excel
Email To
HTML Text     Excel

To use this feature you must register a personal account in My ICL. Registration is free! In My ICL you can save your ICL searches in My Searches, and you can save search results in My Collections. Be sure to use the Held Citations feature to collect citations from an entire search session. Read more search tips.

Sign Into Existing My ICL Account    |    Register A New My ICL Account
Search Tips
  • Enclose phrases in "quotation marks".  Examples: "low back pain", "evidence-based"
  • Retrieve all forms of a word with an asterisk*, also called a wildcard or truncation.  Example: chiropract* retrieves chiropractic, chiropractor, chiropractors
  • Register an account in My ICL to save search histories (My Searches) and collections of records (My Collections)
Advanced Search Tips