Rheumatic manifestations of Paget's disease of bone

Abstract

This study is concerned with the musculoskeletal complaints of 55 patients with symptomatic Paget's disease of bone. The incidence of rheumatic problems, distinct from those attributable to Pagetic involvement of bone, is surprising. The frequency of hyperuricemia and gouty arthritis was unexpected. The level of serum uric acid correlated with the extent and activity of Paget's bone disease. Calcific periarthritis was commonly identified, but was not associated with the extent of bone involved by Paget's disease. Eight patients had rheumatoid arthritis or one of its variant forms; six of the eight had features indistinguishable from ankylosing spondylitis. The character of back pain in these six patients differed from that experienced by those who lacked the clinical features of spondylitis. Articular chondrocalcinosis was an unusual finding. Also studied were the clinical characteristics and the frequency of pain in the knee and the hip, with emphasis on the localization of Pagetic involvement and signs of degenerative joint disease. Paget's disease of bone that is adjacent to joints is associated with pain. The described rheumatic disorders contribute additional important causes of articular and musculoskeletal pain.