Onset of rheumatoid arthritis after surgical treatment of Cushing's disease.
We describe a patient with Cushing's disease who, shortly after trans-sphenoidal surgical resection of an adrenocorticotropic hormone secreting pituitary microadenoma and specifically at the time of normalization of her serum cortisol level, developed a subacute episode of symmetric polyarticular synovitis. This episode lasted for one month; however, it did not resolve completely and progressed after 3.5 years of diffuse arthralgias and morning stiffness to seropositive and erosive rheumatoid arthritis (RA). Review of the literature revealed 3 additional patients with RA with a similar course. These patients may represent a natural illustration of the antiinflammatory effects of supraphysiological levels of endogenous glucocorticoids.
Uthman
I
I
Division of Rheumatology, Hôpital Notre-Dame, Montréal, Canada.
Senécal
J L
JL
D000236:Adenoma / Q000601:surgery; D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001172:Arthritis, Rheumatoid / Q000209:etiology*; D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D013585:Synovitis / Q000209:etiology; D013997:Time Factors