Objective-To describe the incidence, cause, and course of anaemia in rheumatoid arthritis (RA). Methods-Medical records of 225 patients who received a diagnosis of RA between 1990 and 1992 were reviewed longitudinally for mention of anaemia. Anaemia was classified as anaemia of chronic disease if ferritin concentrations reflected adequate body iron stores. Among iron depleted anaemic patients, iron deficiency anaemia was identified using the response to iron supplementation. Results-Anaemia developed in 64% of the patients, mostly within 18 months offollow up, but disappeared again in 540/o of those patients. The prevalence of anaemia varied from 39% to 53% throughout follow up. Iron depletion was found in 38% of anaemic patients; 40% of them did not recover from their anaemia after iron supplementation and were classified as having anaemia of chronic disease. Anaemia of chronic disease thus caused 77% and iron deficiency anaemia 23% of observed anaemia. Recovery from anaemia occurred in 42% of the patients with anaemia of chronic disease and in 72% of iron depleted patients after iron supplementation. Anaemic patients, particularly those with anaemia of chronic disease, had a significantly greater number of the American College of Rheumatism criteria for RA, significantly more erosive joint damage, and significantly increased concentrations of serum rheumatoid factor than patients without anaemia. Anaemia is a frequently occurring extraarticular manifestation in patients with rheumatoid arthritis (RA). Anaemia of chronic disease and iron deficiency anaemia are considered to be the most important causes.'-3The prevalence of anaemia in RA was found to range from 30% to 70% in cross sectional studies.'16 Anaemia of chronic disease, usually distinguished from iron deficiency anaemia by the evaluation of body iron stores, was found in the majority of patients. However, as the diagnosis iron deficiency anaemia can only be confirmed by the results of supplementation with iron,7-9 it is not clear to what extent anaemia of chronic disease and iron deficiency can simultaneously have a role in the development of the anaemia.4 8 Anaemia of chronic disease can be regarded as the result of current inflammation, and has been found to be associated with greater disease activity of RA. '0'4 Although anaemia of chronic disease in general was described as mild and reversible,'3 the long term outcome of anaemia of chronic disease in a large population of patients with RA has not been studied. Iron deficiency has been observed frequently in anaemic patients with RA: thus RA and the treatment of RA may be risk factors for a negative iron balance.'5 However, the frequency of iron deficiency and its relation with iron deficiency anaemia has not been studied in detail.Recently, our department has been involved in extensive research on the pathogenesis, diagnosis, and treatment of anaemia in patients with RA.2 9 16 As a result, there is an active policy towards diagnosis and treatment of anaemia in the patients with RA who are ...
Barriers posed by the COVID-19 pandemic have led to reduced access to Human Immunodeficiency virus (HIV) care, leaving untreated patients at risk for various superimposed infections and malignancies such as Kaposi sarcoma (KS). We recently encountered a 37-year-old African-American male with a past medical history of HIV who tested positive for SARS-CoV-2 and was diagnosed with AIDS-related disseminated KS, representing the first reported case of COVID-19 infection with a newly diagnosed concomitant KS. The patient experienced multi-organ failure requiring tracheostomy, renal replacement therapy, and a prolonged intensive care unit (ICU) stay. Goals of care were changed to comfort measures and the patient passed away shortly afterwards. He was made comfort measures and passed away shortly afterwards. AIDS-related KS is a vascular tumor seen in association with
Human Herpes Virus-8
(HHV-8). Management of limited AIDS-related KS typically includes combined antiretroviral therapy (ART) while multi-organ KS disease demands systemic chemotherapy. Immunosuppression should be avoided in patients with AIDS-related KS as it can lead to progression of KS. This recommendation is in conflict with the usual standard of care for patients with COVID-19 pneumonia, requiring clinical judgment and a customized approach based on the stage and severity of both the KS and the COVID-related disease.
We briefly review HIV-COVID-19 coinfection, AIDS related KS and challenges associated with their management.
IgG4-related lung disease is an extremely rare and novel entity which is still poorly understood. We reviewed the 16 patients diagnosed with IgG4-related disease from October 2014 through December 2019 at our institution. The three cases that showed pulmonary involvement are included in this series. Of these, two patients had cavitary lung disease and developed aspergilloma and chronic cavitating aspergillosis after a prolonged course of steroid therapy, and one had isolated pulmonary nodule and ground glass opacity. We reviewed the updated literature and briefly described disease epidemiology, clinical characteristics, diagnostic approaches, and management strategies for IgG4-related lung disease.
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