Endocrine Abstracts

Rheumatoid arthritis is a systemic autoimmune inflammatory disease characterized by severe pain, if left untreated. Primary hyperparathyroidism is a systemic disorder characterized by disordered calcium metabolism leading to increased serum calcium and PTH levels. Primary hyperparathyroidism may be due to the presence of a parathyroid adenoma or parathyroid hyperplasia. The aim was to present a cohort of patients with rheumatoid arthritis who presented with primary hyperparathyroidism.A cohort of patients with rheumatoid arthritis is presented. Three patients with active rheumatoid arthritis are described. Patients were female, aged 58, 65 and 67 years old. They had seropositive rheumatoid arthritis, anti-CCP positive, rheumatoid factor positive and had severe pain on treatment with methotrexate and corticosteroids. During laboratory evaluation increased calcium levels were observed along with increased PTH levels.In further evaluation an ultrasonogram revealed the presence of a parathyroid adenoma adjacent to the thyroid in two of the patients, while in the other scintigraphy with 99 mTc-SESTAMIBI was performed which revealed an adenoma beneath the left lobe of the thyroid gland. Surgical removal of the parathyroid adenomas was planned. For the management of rheumatoid arthritis biologic therapy was introduced.Primary hyperparathyroidism in the context of rheumatoid arthritis is rare. If diagnosed it may require surgical removal of the parathyroid adenoma as increased calcium levels may aggravate pain in the setting of systemic inflammation. The diagnosis of primary hyperparathyroidism in the setting of rheumatoid arthritis may be due to routine screening for calcium levels on biochemical evaluation in modern times.