الهه دولتشاهی - فوق تخصص روماتولوژی هییت علمی واحد توسعه تحقیقات بالینی رجایی مرکز آموزشی درمانی شهید رجایی دانشگاه علوم پزشکی البرز کرج ایران
مهشید پاک کیش - دانشجوی پزشکی دانشکده پزشکی دانشگاه علوم پزشکی البرز کرج ایران

Introduction:Paget’s disease of bone (PDB) is rare osseous dysplasia seen in the middle-aged and elderly. It can be monostotic or polyostototic, the former being the more common form of the disease, affecting the axial skeleton. It is characterized by focal alteration of bone remodeling, which leads to bone with an anomalous structure and altered mechanical properties, associated with pain and pathological fractures.Case report:We report the case of 70-year-old man with the complaint of poly arthralgia especially suffering from pain in both legs. He claimed that he has rheumatoid arthritis (RA) for years. On examination severe DJD genu varum and great tenderness in both legs was seen; So radiologic, biochemical investigations were performed. Biochemical tests revealed high ESR CRP and extreme increase of ALP (=1200). X-ray was compatible with Paget’s disease just like bone scan. Correlating the clinical, radiologic and biochemical findings final diagnosis of PDB was established.Conclusion:Paget’s disease is rare bone disease which may be asymptomatic initially or has various manifestation. The estimated prevalence of Paget disease in patients aged 55 years or older has decreased to approximately 2%. This case that has been treated as RA patient finally was established PDB; So the differential diagnosis of Paget disease includes osteomalacia and RA.

Paget disease Poly arthralgia Alkaline phosphatase