title: Hypercalcemia and Lytic Bone Lesions Masquerading Inflammatory Arthritis Treated as Rheumatoid Arthritis.
abstract: Hyperparathyroidism is a complex clinical syndrome characterized by dysfunction in the metabolism of bone, calcium and phosphorus. Rheumatologic manifestations are common amongst patients with hyperparathyroidism. We report a 50-year-old woman with hypercalcemia, lytic bone lesions and inflammatory arthritis of both hands that were not resolved after parathyroidectomy. Laboratory evidence of elevated erythrocyte sedimentation rate, positive C-reactive protein (CRP) and high titers of anti-CCP and rheumatoid factor was diagnostic of rheumatoid arthritis (RA) according to European League Against Rheumatism criteria. Eventually, with the concomitant diagnoses of hyperparathyroidism and RA, she was treated with methotrexate and hydroxychloroquin. Hyperparathyroidism may present with rheumatologic manifestations, leading to an initial misdiagnosis. Furthermore, attention to this fact that hypercalcemia is not commonly associated with RA, and rather suggestive of a concomitant disorder, is crucial to the diagnosis of hyperparathyroidism in RA patients with hypercalcemia.
authors.affiliation: Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Salari
authors.affiliation: Endocrine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Robab Bigom
authors.initials: RB
authors.lastname: Aboutorabi
authors.affiliation: Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Rezaieyazdi
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology; D006961:Hyperparathyroidism / Q000601:surgery*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016105:Parathyroidectomy; D012217:Rheumatoid Factor / Q000097:blood*
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D008727:Methotrexate