Elbeialy Syndrome

We have characterized a syndrome of VitaminD3 deficiency/ Fibromyalgia/ Hyperparathyroidism mimicking Rheumatoid Arthritis. It is characterized by longstanding vitamin D3 deficiency, associated with hyperparathyroidism and fibromyalgia, predominantly negative Anti-CCP, while RF may be low positive. Radiologically it is characterized by the presence of finger tuft acro-osteolysis with spur-like excrescences which is pathognomonic, besides other features of hyperparathyroidism including subperiosteal and subchondral resorption of mainly thumbs, subchondral osteopenia of proximal and middle phalanges, mild subperiosteal resorption along the radial aspect of the middle phalanx and mild tuft erosions, besides changes in the carpus closely resembling those of rheumatoid arthritis, of ulnar styloid resorption, radiocarpal and scapho-trapezoid joint arthritis. This syndrome responds well to treatment of fibromyalgia regimen of SSRI, muscle relaxants, and vitamin D3 supplementation 5000-10000 iu/day, in addition to sulphasalazine 1-2 gm/day to which their inflamed joints responded significantly.