Sterile Osteitis and Suppurative Arthritis Associated with Pannus Responding to Colchicine

Sterile suppurative arthritis is characterized by neutrophilic infiltration of joints without any causative pathogen. Here, we present a 32-year-old man with refractory osteitis and erosive suppurative oligoarthritis with pannus. Treatments with multiple disease modifying antirheumatic drugs were all unsuccessful. However, he had clinical response to colchicine and the synovial hypertrophy and the pannus in the MRI of his left shoulder resolved. In this case, the effects of colchicine on neutrophils might have played a role in treating neutrophilic sterile suppurative arthritis, which, in adults, might be a distinct oligoarticular disease. 1. Introduction Sterile suppurative arthritis is a rare disease, characterized by neutrophilic infiltration of joints similar to septic arthritis, but without any causative pathogen in microbiologic studies [1]. It is also among the descriptive symptoms of pyogenic arthritis, pyoderma gangrenosum, and acne syndrome (PAPA). Sterile suppurative arthritis in PAPA syndrome has been shown to benefit from IL-1 blockade, as well as anti-TNF treatment [2]. Here, we present a patient with osteitis and suppurative erosive arthritis who had a dramatic response to colchicine therapy. 2. Case Presentation A 32-year-old man, with no significant past medical history except acne in facial region, presented with complaints of intermittent pain and swelling in his right wrist for the last six months. Physical examination was unremarkable except for the swelling, warmth, and tenderness in the right wrist and acneiform lesions on his face. Laboratory evaluation revealed elevated erythrocyte sedimentation rate (ESR) (60？mm/hour) and C-reactive protein (CRP) (24？mg/L); however, rheumatoid factor and anticyclic citrullinated peptide, as well as HLA B27, tests, were found negative. There was no evidence of radiographic sacroiliitis on plain radiography. His skin biopsy from acneiform lesions revealed periadnexal, perivascular, and interstitial neutrophil rich inflammatory infiltrate suggesting acne rosacea. Magnetic resonance imaging (MRI) of the right wrist disclosed contrast enhancement in the distal radius suggesting inflammatory or infectious process, that is, osteomyelitis. Broad spectrum antibiotics, that are effective for both Gram-positive and -negative bacteria, including tetracycline were started. There was no improvement despite treatment with various types of antibiotics for six months. Therefore, synovial biopsy from the right wrist was done. Pathology revealed suppurative arthritis but disclosed no infectious pathogen, such as