Abstract
Background A 49-year-old man presented at a hospital with an arthritic flare-up and stress dyspnea with a cough. He had a 5-year history of symmetrical polyarthritis, for which he was prescribed 5–15 mg prednisolone daily. He was subsequently diagnosed with rheumatoid arthritis and prescribed 20 mg methotrexate weekly, 3 mg/kg ciclosporin daily and 5 mg prednisolone daily. Infliximab therapy was initiated after 3 months because of persistent joint pain and inflammation. Six months later, however, the patient was readmitted to hospital with a new arthritic flare-up, acute retrosternal chest pain and stress dyspnea.
Investigations Laboratory analyses, electrocardiography, chest radiography, high-resolution CT, echocardiography, technetium-99m-labeled (99mTc)-methoxyisobutyl-isonitrile stress myocardial scintigraphy and coronary angiography.
Diagnosis Lupus anticoagulant and ischemic myocardial microangiopathy.
Management Drug therapy with prednisolone, methotrexate, anakinra, aspirin and clopidogrel.
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Ferraccioli, G., Zoli, A., Alivernini, S. et al. Lupus anticoagulant and ischemic myocardial microangiopathy in rheumatoid arthritis. Nat Rev Cardiol 3, 339–343 (2006). https://doi.org/10.1038/ncpcardio0576
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DOI: https://doi.org/10.1038/ncpcardio0576
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