A 41-year-old male with a history of ulcerative colitis was referred to the Rheumatology Clinic for bilateral gonalgia.
At the time of diagnosis of IBD, thirteen years earlier, cyclosporine and severe ulcerative pancolitis (E3 according to the Montreal Classification and confirmed by biopsy) were observed, requiring the control of corticoyloid disease.
Currently, the patient was treated with a desktop with good clinical response except for mild sprouts controlled with short cycles of oral corticosteroids.
In the last two years he had mechanical pain in both knees.
Physical examination revealed mild synovitis in the right knee without joint effusion; mobility of the spine was normal and sacroiliac maneuvers were negative.
The strength, sensitivity and tone were normal.
There was no ocular or cutaneous involvement.
Complete blood tests (including ESR and CRP) were within normal limits; in the immunological study performed, the following stood out: positive ANA 1/160 (granular pattern), negative anticardiolipin antibodies and lupus anticoagulant.
Proteinogram, thyroid hormones and iron study were normal.
Plain radiographs of the shoulders, elbows, accused hips and sacroiliac joints showed no pathological findings; however, radiographs of the right knees revealed findings suggestive of bone infarctions, associated with incipient changes.
With the suspicion of avascular necrosis of the knees, treatment with acetylsalicylic acid and simvastatin was initiated, as well as calcium and vitamin D for the prevention of osteoporosis.
He is currently asymptomatic.
