Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by symmetric inflammatory polyarthritis. However, RA limited to a single joint is extremely rare. Here, we report a middle-aged woman who presented with insidious right elbow arthritis. She had no other peripheral joint pain, tenderness or swelling. She had high-positive anti-cyclic citrullinated peptide antibodies. An MRI of the right elbow showed capsular distension, joint effusion and bone marrow oedema. Synovial biopsy revealed hyperplasia with lymphoplasmacytic infiltrate consistent with RA. Therapy with methotrexate 7.5 mg orally weekly was effective to control her inflammatory arthritis. This case highlights the relevance of synovial tissue analysis for patients presenting with chronic inflammatory monarthritis when the cause is not clinically evident, and the importance of considering RA even in the absence of polyarticular involvement. Delayed diagnosis and treatment of inflammatory monarthritis can lead to joint destruction and disability.
- rheumatoid arthritis
- musculoskeletal syndromes
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Contributors I certify that all authors have participated sufficiently in this work to take responsibility for the work and to qualify as authors as defined in the Uniform Requirement for Manuscript Submitted to Biomedical Journals. The following are the contributions for each author: (1) Substantial contribution to acquisition of data (AS, SMC-R, MC-R, LMV). (2) Drafting the article or revising it critically for important intellectual content (AS, SMC-R, MC-R, LMV). (3) Final approval of the version of the article to be published (AS, SMC-R, MC-R, LMV).
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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