Reumatol Clin. 2015;11(5):325–327 ww w.reumato logiac l in ica.org Images in Clinical Rheumatology

The patient in question is a 44 year old male with a history of alcohol abuse. He came to the consultation due to episodes of mono/oligoarthritis of the hands and ankles, recurring every week for 5 years, and inflammatory back pain of 10 years of evolution, with alternating buttock pain. He reported no other accompa-nying symptoms. Examination revealed the presence of arthritis of the right wrist, left 4th and 5th PIP with accompanying nod-ules. Laboratory tests showed uric acid 13.2 mg/dl, ESR 44 mm/h (0–20) CRP 15 mg/l (<5 mg/l) and a Mantoux test of 20 mm. The remaining tests (CBC, TSH, CPK, rheumatoid factor, HLA-B27, anti-citrullinated-peptide antibodies, immunoglobulins, antibodies fo