Poncet’s Disease in the Preclinical Phase of Rheumatoid Arthritis

Abstract

We report on a patient with seropositive polyarthritis retrospectively diagnosed as Poncet's disease in the preclinical phase of seropositive rheumatoid arthritis. Our patient developed rheumatoid arthritis more than 2 years after being successfully treated for pulmonary tuberculosis and an initial inflammatory polyarthritis consistent with the diagnosis of Poncet's disease. This case illustrates the importance of recognizing Poncet's disease in a patient presenting with polyarthritis in order to avoid inappropriate long-term disease modifying antirheumatic treatment. It also illustrates the need for adequate follow-up of patients with Poncet's disease after treatment with antituberculosis treatment so that progression to a primary inflammatory arthritis such as rheumatoid arthritis may be identified timeously. Although seropositivity for rheumatoid arthritis has been reported in Poncet's disease as well as in tuberculosis, it is rather uncommon, and long-term follow-up of patients with Poncet's disease is essential particularly if they have positive serological tests for rheumatoid arthritis. In this case report, we describe the first reported case of Poncet's disease in the preclinical phase of rheumatoid arthritis and review the literature related to this rare disease presentation.

A case of Poncet’s disease; a mimicker of rheumatoid arthritis

“…Furthermore, seropositivity of RF and anti-CCP antibodies have been reported in PD similar to our patient fulfilling American College of Rheumatology and European League Against Rheumatism criteria for Rheumatoid arthritis (1,8,9). Therefore, RF and anti-CCP seropositive arthritis should not automate to the diagnosis of rheumatoid arthritis (1,2,8,9). There are no standard definitions and diagnostic criteria widely used in clinical practice to identify PD (3,4).…”

“…Tuberculosis infections in particular were associated with seropositive RF (8-60%) and anti-CCP (7-39%) antibodies (1,9). Furthermore, seropositivity of RF and anti-CCP antibodies have been reported in PD similar to our patient fulfilling American College of Rheumatology and European League Against Rheumatism criteria for Rheumatoid arthritis (1,8,9). Therefore, RF and anti-CCP seropositive arthritis should not automate to the diagnosis of rheumatoid arthritis (1,2,8,9).…”

“…After multidisciplinary team discussion including general physician, respiratory physician and Rheumatologist, patient was commenced on the category 1 anti-TB treatment (isoniazid 5 mg/kg, rifampicin 10 mg/kg, pyrazinamide 25 mg/kg and ethambutol 15 mg/kg) according to the World Health Organisation (WHO) tuberculosis guidelines (8). At three months his joint pains have completely resolved.…”

Disseminated Mycobacterial Infection With Reactive Polyarthritis (Poncet’s Disease) During Immune-suppressive Treatment Including Ustekinumab for Pediatric Crohn’s Disease

“…[39][40][41] The exact pathogenetic mechanism is unknown, but it is hypothesized that PD is an immunologically mediated disorder caused by molecular mimicry between TB and host cartilage antigens in genetically predisposed individuals. 42 Diagnostic criteria, proposed by Rueda et al, 43 include (1) evidence of active extra-articular TB; (2) involvement of more than 1 joint, including the knees and ankles; (3) absence of axial, vertebral or sacroiliac involvement; (4) nonspecific laboratory findings; (5) complete remission after anti-TB therapy; (6) absence of chronic joint impairment and (7) exclusion of other rheumatologic diseases. In the case herein described, 6 diagnostic criteria are completely fulfilled and 1 (no.…”

Poncet′s disease (tubercular rheumatism): a narrative review

“…Cases once treated as PD, may rarely be diagnosed as RA in future and for which disease modifying drugs might be used then. 41 In another case of PD treated with ATT for relief in polyarthralgia and low back pain, adalimumab was administered for remaining enthesitis and tendinitis. 42 Development of PD after BCG instillation for urogenital malignancy is also reported in the literature with final diagnosis of PD and subsequent improvement on BCG discontinuation and ATT.…”