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January 30, 2008

Joint Problems and Cystic Fibrosis

JAMA. 2008;299(4):408. doi:10.1001/jama.299.4.408-b

To the Editor: The Grand Rounds on adult cystic fibrosis by Dr Boyle1 did not discuss associated musculoskeletal features, an area of concern that may become more prominent as patients with cystic fibrosis live longer and better lives.

Joint problems were first described in children with cystic fibrosis almost 40 years ago, and rheumatic symptoms are common, occurring in up to one-third of adult patients with cystic fibrosis.2 However, joint problems have not received much attention in the medical literature, particularly in adults. The major expressions are episodic inflammatory arthropathy and hypertrophic pulmonary osteoarthropathy.2 A subgroup of patients with episodic inflammatory arthropathy may develop persistent synovitis with progressive, asymmetric, and erosive joint disease.3 An etiologic association with circulating immune complexes, rheumatoid factor titers higher than in healthy controls, and antibodies to heat shock proteins related to the underlying infectious exacerbations has been proposed.3,4