A case of multiple sclerosis associated with rheumatoid arthritis and positive anticardiolipin antibodies

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Abstract
A 48 year old man presented to the orthopaedic clinic with left knee and foot pain and an associated mild weakness on the left side. Examination confirmed patellofemoral crepitus, and spastic paraparesis. A diagnosis of MS was made, supported by oligoclonal bands in cerebral spinal fluid, delayed visual evoked responses, and magnetic resonance imaging studies which showed high intensity areas in the brainstem tegmentum and periventricular white matter. His main deficit was spasticity of the legs and intermittent pains in hands and feet. He was mobile with crutches. Baclofen or dantrolene in therapeutic doses did not improve his spasticity.