Journal of Physical Medicine Rehabilitation & Disabilities Category: Medical Type: Case Report
Rheumatoid Arthritis Concomitant with Brucellosis: Case Report in Addition to Clinical and Rehabilitation Outcomes
- Tarek M El-gohary1*, Samiha M Abd Elkader2
- 1 Department Of Physical Therapy, College Of Medical Rehabilitation Sciences, Taibah University, Saudi Arabia
- 2 Department Of Rehabilitation Health Sciences, College Of Applied Medical Sciences, King Saud University, Saudi Arabia
*Corresponding Author:Tarek M El-gohary
Department Of Physical Therapy, College Of Medical Rehabilitation Sciences, Taibah University, Saudi Arabia
Received Date: Jan 11, 2019 Accepted Date: Feb 12, 2019 Published Date: Feb 26, 2019
Symptoms control and physical capacity are fundamentals in patients with Rheumatoid Arthritis, but when concomitant with Brucellosis it becomes another challenge. Case Report: A 48- year old Saudi male patient presented with bilateral swollen knees and ankles, bilateral adductors’ tendinitis, and left shoulder tendinitis, generalized body ache in addition to physical functional decline. The patient was diagnosed with Rheumatoid arthritis 40 months ago and since then he has been on medications. The patient was also diagnosed with brucellosis five months ago and was on medications but he has been suffering from exacerbation of many symptoms since. The patient was slowly but steadily responding to physical therapy interventions but since he had developed Brucellosis, controlling symptoms become more difficult and necessitates ongoing physical therapy management and follow up with the designated medical doctors.
It is not uncommon to have a flare up of the current Rheumatoid arthritis in addition to acquiring Brucellosis especially in the endemic areas; therefore physical therapists and rehabilitation clinicians should consider presence of more than one disease which needs thorough evaluation and prudent rehabilitation program.
After 4 weeks of physical therapy, patient has better posture, good/normal right knee strength, grade 1+ of right knee effusion, good/ normal trunk balance and stability, better quality of shoulders’ mobility, steadier and faster gait pattern. Patient is showing more mobility to transit between standing and squatting but could not managed to fully squat. Patient also managed to execute 5x sit-to- stand test in 21 seconds. Patient has shown fair progress but still far from age matched community ambulant group who had 6.2 ± 1.3 seconds . Left knee swelling did not show any improvement; it has grade 3+ effusion, periarticular swelling and feels hot. Both ankles still have grade 1+ joint effusion. Clinically, grade 3+ is more serious reaction to the disease or the activity. Moreover, effusion causes capsular distension, diminishes the quadriceps efficiency and leads to pathomechanical consequences. Physical therapists should primarily emphasize on controlling the joint swelling to proceed with different rehabilitation techniques .
Moreover, hip adductors tendinitis and shoulder tendinitis showed slow and minimal improvement. Patient was educated to use cold applications, hydrotherapy and assistive technology to provide symptomatic relief. Aerobic exercises should be tailored to fit patient’s interim functional capacity aiming to combat the destructive disease effect . The patient raised the concern of keep losing his body weight despite finishing the medications being taken for brucellosis. The physician prescribed doxycycline and gentamicinantibiotics in addition to corticosteroids for treating Brucellosis. Patient stated that he received the treatment for 3 month and since then is being carefully monitored . He has been told that he still has the antibodies of the disease. It always takes up to 12 month to be out of the bone [10,14].
CONFLICT OF INTEREST
- Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, et al. (2009) British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Rheumatoid Arthritis (the first two years). Rheumatology 48: 436-439.
- Brocq O, Millasseau E, Albert C, Grisot C, Flory P, et al. (2009) Effect of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine 76: 350-355.
- Verhoef J, Toussaint PJ, Zwetsloot-Schonk JHM, Breedveld FC, Putter H, et al. (2007) Effectiveness of the introduction of an International Classification of Functioning, Disability and Health-based rehabilitation tool in multidisciplinary team care in patients with rheumatoid arthritis. Arthritis Rheum 57: 240-248.
- Duyur B, Erdem HR, Ozgocmen S (2001) Paravertebral abscess formation and knee arthritis due to Brucellosis in a patient with rheumatoid arthritis. Spinal Cord 39: 554-556.
- Mert A, Ozaras R, Tabak F, Bilir M, Yilmaz M, et al. (2003) The sensitivity and specificity of Brucella agglutination tests. Diagn Microbiol Infect Dis 46: 241-243.
- Furst DE (2010) The risk of infections with biologic therapies for rheumatoid arthritis. Seminars in Arthritis and Rheumatism 39: 327-346.
- Colmenero JD, Reguera JM, Martos F, Sánchez-de-Mora D, Delgado M, et al. (1996) Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine 75: 195-211.
- Colmenero JD, Reguera JM, Fernandez-Nebro A, Cabrera-Franquelo F (1991) Osteoarticular complications of brucellosis. Ann Rheum Dis 50: 23-26.
- Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H (2011) Osteoarthritis involvement among 202 Brucellosis cases identified in central Anatolia region of Turkey. Intern Med 50: 421-428.
- Geyik MF, Gür A, Nas K, ?evik R, Sarac J, et al. (2002) Musculoskeletal involvement in brucellosis in different age groups: a study of 195 cases. Swiss Med Wkly 132: 98-105.
- Aydin M, Fuat Y, Savas L, Reyhan M, Pourbagher A, et al. (2005) Scintigraphic findings in osteoarticular brucellosis. Nuc Med Commun 26: 639-647.
- Memish ZA (2001) Brucellosis control in Saudi Arabia: prospects and challenges. J Chemother 13: 11-17.
- Bohannon RW, Shove ME, Barreca SR, Masters LM, Sigouin C (2007) Five-repetition sit-to-stand test performance by community-dwelling adults: A preliminary investigation of times, determinants, and relationship with self-reported physical performance. Isokinetics and Exercise Science 15: 77-81.
- Güzey FK, Emel E, Sel B, Bas NS, Özkan N, et al. (2007) Cervical spinal Brucellosis causing epidural and paravertebral abscesses and spinal cord compression: a case report. Spine J 7: 240-244.
Citation: El-gohary TM, Abd Elkader SM (2019) Rheumatoid Arthritis Concomitant with Brucellosis: Case Report in Addition to Clinical and Rehabilitation Outcomes. J Phys Med Rehabil Disabil 5: 031.
Copyright: © 2019 Tarek M El-gohary, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.