Morphea with Seronegative Inflammatory Arthritis and Normal Acute Phase Reactants: A Case Report

Authors

• Balakrishnan Navaneethakrishnan, Avinash Hospitals ChennaiFollow
• MAHABALESHWAR MAMADAPUR, Department of Clinical Immunology and Rheumatology, JSS Medical College and Hsopital, JSS Academy of Higher Education and ReseachFollow

Author ORCID Identifier

https://orcid.org/0000-0003-1607-6563

https://orcid.org/0000-0001-7421-2418

Corresponding Author

Balakrishnan Navaneethakrishnan

nbkzzzz22@gmail.com

Abstract

Localised scleroderma, also known as morphea, is an immune-mediated fibrosing disorder that primarily affects the skin and subcutaneous tissues. While traditionally considered purely a cutaneous disease, extracutaneous manifestations (especially inflammatory arthritis) are increasingly being appreciated. The combined presence of morphea and inflammatory arthritis is rare and can be difficult to diagnose, particularly when inflammatory markers and serological testing are non-contributory.

Case Summary : We describe a 41-year-old woman with long-standing biopsy-proven morphea who over 2 years developed chronic, asymmetric inflammatory arthritis of the left wrist and hand small joints. On examination, she had active synovitis with restricted movements of her wrist, classical hyperpigmented plaques on her face with dermal sclerosis and feature of linear sclerotic band over her forehead. Laboratory findings including erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, anti-cyclic citrullinated peptide antibodies, and antinuclear antibodies, were within normal limits. Magnetic resonance imaging of the left wrist demonstrated joint space narrowing, cartilage thinning, erosions, subchondral cysts, bone marrow edema, and synovial thickening, confirming inflammatory arthritis. The patient showed significant clinical improvement following treatment with tapering corticosteroids, methotrexate, and structured physiotherapy.

Conclusion : This case highlights that inflammatory arthritis may occur in morphea despite normal inflammatory markers and negative serology, emphasizing the importance of early recognition and multidisciplinary management to prevent irreversible joint damage.

Publication Date

Summer 3-1-2026

Publisher

Balakrishnan Navaneethakrishnan

Conflict of Interest

nil

Keywords

Morphea, Localized Scleroderma, Inflammatory Arthritis, Seronegative Arthritis, Magnetic Resonance Imaging

Word Count

1113

Comments

none 

Recommended Citation

Navaneethakrishnan B, MAMADAPUR M. Morphea with Seronegative Inflammatory Arthritis and Normal Acute Phase Reactants: A Case Report. Digital Journal of Clinical Medicine. 2026; 8(1): -. doi: https://doi.org/10.55691/2582-3868.1303

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Cover Page Footnote

I intend to publish an article entitled “Morphea with seronegative inflammatory arthritis and normal acute phase reactants : A case report” in your esteemed journal as a case report. The manuscript has been read and approved by all the authors, that the requirements for authorship as stated in this document have been met, and that each author believes that the manuscript represents honest work.