A Joint Venture

A CLINICAL PROBLEM-SOLVING article by Abraham Schwarzberg from Massachusetts General Hospital, Boston.
A 59-year-old woman presented with new-onset oligoarthritis and extreme fatigue. 6 weeks earlier, she noted a gradual onset of pain and swelling in her right knee. Two weeks before presenting for care, she began to experience pain in her left knee, followed by an onset of pain and swelling in her left ankle and left wrist. The pain in her joints worsened with movement. In the previous 2 weeks, she had noted fatigue and progressive dyspnea on exertion.
On physical examination, the patient appeared fatigued. The left wrist joint was swollen, with a limited range of motion. Both knees were swollen, warm, erythematous, and painful on palpation. There was periarticular swelling, a reduced range of motion, and pain in her left ankle.
The erythrocyte sedimentation rate and serum ferritin level were strikingly high.
A bone marrow biopsy was warranted.
A few days after admission, the patient's body temperature rose to 39.1°C, and a rash appeared bilaterally on her anterior shins. The rash was erythematous, nonblanching, palpable, nontender, and nonpruritic.
The core-biopsy specimen was nondiagnostic but contained a population of intermediate-size, immature mononuclear cells.
In this case, the joint aspiration provided important additional information.

タイトルのJOINTは、関節と結合を掛けたのでしょう。中年期以降の突発する「関節炎と貧血」の組み合わせは、背景に重篤な疾患を考えましょう、とのこと。