AB0648 REACTIVE ARTHRITIS IN SYPHILIS MIMICKING RHEUMATOID ARTHRITIS: A CASE REPORT

Background: Reactive arthritis is a form of spondyloarthritis with aseptic joint involvement occurring after gastrointestinal or urogenital infection. Most commonly associated Chlamydia trachomatis , Salmonella, Shigella, Campylobacter and Yersinia. Syphilis an infection caused by the spirochete Treponema pallidum not usually reactive arthritis. great imitator other diseases due to its broad presentation including painless chancre, constitutional symptoms, adenopathy, rash, synovitis, neurological ocular findings. Objectives: To discuss patient who presented symptoms rheumatoid (RA) but was later diagnosed syphilis. Methods: 31 year old male, former tobacco smoker, referred Rheumatology for sudden onset pains, elevated anti-cyclic citrullinated peptide (anti-CCP), inflammatory markers. He reported pain in bilateral wrists, fingers, right elbow 6 weeks. Associated 45 minutes morning stiffness new lower back without stiffness. denied trauma, fever, chills, skin dysuria, diarrhea. Initiated trial naproxen 500mg twice day only have minimal relief. Patient sexually active men recently oropharyngeal gonorrhea treated azithromycin 4 months prior. All STI screening syphilis, gonorrhea, HIV were negative at that time. on emtricitabine tenofovir disoproxil fumarate pre-exposure prophylaxis. family history immune mediated conditions. Exam significant mild synovitis both wrists 2nd metacarpophalangeal joints. Initial labs revealed weakly positive anti-CCP 21 (normal <20), sedimentation rate 64 ESR 0-15 mm/hr), C-reactive protein 24 CRP 0-10 mg/L), RF, ANA, HLA B27. During short prednisone taper, there temporary improvement however recurred upon completion. Hydroxychloroquine (HCQ) 200mg started possible RA he Ophthalmology baseline retinopathy screening. Incidentally, developed sided blurry vision 2 weeks initiation HCQ. panuveitis eye inflammation optic nerve head 40mg daily initiated presumed manifestation RA. However, further workup antibody RPR quantity 1:32. Prednisone immediately discontinued emergency department neurosyphilis. Results: Lumbar puncture showed cerebral spinal fluid 260 red blood cells, 1 white cell, 27mg/dL protein, 60mg/dL glucose, non VDRL, IgG antibody, cultures. Meningitis encephalitis panels negative. completed 14 course IV penicillin G complete remission pain, visual normalization anti-CCP, ESR, CRP. Conclusion: This case highlights how syphilis may mimic signs symmetrical small stiffness, markers, anti-CCP. Anti-CCP >96% specific false this patient. There been few cases noting rare secondary resolution treating References: [1]Carter JD. Treating arthritis: insights clinician. Ther Adv Musculoskelet Dis. 2010 Feb;2(1):45-54. [2]Cohen SE, Klausner JD, Engelman J, Philip S. modern era: update physicians. Infect Dis Clin North Am. 2013 Dec;27(4):705-22. [3]Singh Sangha M, Wright ML, Ciurtin C. Strongly antibodies patients sacroiliitis post-E. coli infection: A mini case-series based review. Int J Rheum 2018 Jan;21(1):315-321. Disclosure Interests: None declared.