Vasculitis is a late complication in rheumatoid arthritis (RA) and is seen in RA patients with long-standing disease. Rheumatoid vasculitis affects small-to-medium-sized vessels. In a few patients, vasculitis develops early in the course of the disease. Here, we report the case of a 32-year-old female who presented with gangrene in the second and third digits of the right foot and gangrene in the second digit of the left foot. She was on hydroxychloroquine and methotrexate for one year since the diagnosis of RA. The patient then developed Raynaud's phenomenon and blackish discoloration of toes. She was started on pulse methylprednisolone, aspirin, nifedipine, and pentoxifylline. As no improvement was seen, intravenous cyclophosphamide was started. There was no improvement even after starting cyclophosphamide, and the gangrene further worsened. Eventually, after consulting the surgical team, it was decided to amputate the digits. The second digits in both feet were subsequently amputated. Hence, a physician should always be careful in checking for signs of vasculitis in RA patients early in the course of the disease as well.
Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has considerable cardiovascular risk. Various cardiovascular diseases are common during exacerbations. Both diseases share several similarities such as older age of the patient, smoking as a common risk factor and symptoms of exertional dyspnea. Knowledge regarding the magnitude of underlying cardiovascular diseases during AECOPD is limited. Authors performed this study to assess the presence of different associated cardiovascular diseases (CVDs) in patients hospitalized for AECOPD and its effect on the outcome.Methods: It was a prospective observational study involving 436 patients of AECOPD divided to Group 1 (AECOPD with CVD- 137 (31.4%) patients) and Group 2 (AECOPD without CVD 299 (68.6%) patients). All the patients were subjected to full history taking, clinical examination, chest X-ray, spirometry, ECG and echocardiography.Results: COPD patients in exacerbation with CVD, were significantly more likely to have longer duration of hospital stay (p < 0.0001), high CRP level (p<0.001), more frequent mechanical ventilations (p < 0.001), two or more exacerbations per year (p <0.0001) and the mortality was (p<0.0001). Also, they have GOLD grade III/IV severe (43.5%) and very severe (19.5%) air flow limitation. The high percentage of them had (64.8%) pulmonary hypertension, (37.3%) systemic arterial hypertension, (31.5%) arrhythmia, (27.8%) ischemic heart diseases and (21.3%) heart failure.Conclusions: The prevalence of cardiovascular diseases (CVD) in patients hospitalized for COPD was high. Age, sex and CVD trends, as well as life style changes, should be considered when prevention and control strategies are formulated.
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