Abstract
The pathogenesis of human immunodeficiency virus (HIV) associated spondyloarthropathy (SpA) is poorly understood. In this case report a patient is described with severe HIV associated reactive arthritis, who on magnetic resonance imaging and sonographic imaging of inflamed knees had extensive polyenthesitis and adjacent osteitis. The arthritis deteriorated despite conventional antirheumatic treatment, but improved dramatically after highly active antiretroviral treatment, which was accompanied by a significant rise in CD4 T lymphocyte counts. The implications of the localisation of pathology and effect of treatment for pathogenic models of SpA and rheumatoid arthritis in the setting of HIV infection are discussed.
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Figure 1 .
(A) Sagittal fat suppressed MR image of the left knee showing extensive bone oedema at several sites. It is maximal at the patella (curved black arrow), tibial plateau, and femoral condyle (asterisks) and anterior to the patellar tendon origin (white arrow heads). (B) Adjacent image from the medial aspect of the same joint showing bone oedema at the tibial plateau (black asterisk) with extensive extracapsular oedema (black arrows).
Figure 2 .
Sonographic image of the medial aspect of the same joint showing the medial collateral ligament insertion. There is ligament thickening and oedema (white asterisk) and bone erosion (white arrows). Similar patterns of erosive enthesitis were also evident in the lateral collateral ligaments and patellar tendons.