A case of chronic erosive polyarthritis which developed 14 years after an intestinal bypass operation with subsequent remission by intestinal revision

: A 38-year-old female patient developed the symptoms and signs of arthritis in the right tarsal joint for the first time after 14 asymptomatic years following an ileo-colic intestinal bypass operation which had been performed as an emergency procedure for acute ileus due to intestinal adhesions caused by the previous abdominal surgery. Her arthritis took a progressively severe course thereafter, primarily involving the joints of both lower extremities, and 13 years after the onset of symptoms she still continued to have active polyarthritis. However, no concomitant skin lesions of any form had been recognized throughout the course of the arthritis. On the articular radiographs erosive changes were evident in the right tarsal joints and also in the MTP joints of both big toes. Laboratory examinations of the serum revealed negative results for rheumatoid factor, circulating immune-complexes, anti-nuclear antibodies, and anti-DNA antibodies, while the serum level of CRP as well as the erythrocyte sedimentation rate were elevated. Other routine laboratory tests were all unremarkable, and neither HLA-B 27 nor HLA-DR 4 were positive. Therapeutic drug regimens consisting of NSAIDs, oral as well as intraarticular steroids, DMARDs, methotrexate, and combinations of these drugs were unsuccessful in controlling the severe symptoms of the arthritis. In view of this, a revision operation of intestinal bypass was performed 13 years after the onset of the arthritis. After the revision the severe pain of the arthritis began to subside gradually, and 1 year and 6 months later the patient achieved complete remission of the arthritis, and her CRP and ESR values returned to normal.