A Case of Superficial Thrombo-occlusive Vascular Disease in a Patient With Rheumatoid Arthritis

Abstract

An 86-year-old female patient was diagnosed with seropositive rheumatoid arthritis (RA) in March 2019 and she also had approximately ten-year history of diabetes mellitus, hypertension, dyslipidemia, osteoporosis, and total knee replacement in her left knee joint in 2014. She had been treated with methotrexate, leflunomide, and prednisolone for RA, then tofacitinib was added for uncontrolled disease activity of RA in December 2019, symptoms and signs of arthritis subsided and she was treated on methotrexate, tofacitinib and methylprednisolone 2 mg daily thereafter. In April 2020, she developed erythematous papules, palpable purpura, and ulcers on the left lower leg, and visited the department of dermatology. There were no other systemic symptoms and signs, and laboratory tests were nonspecific. Suspicious of leukocytoclastic vasculitis (LCV), an al-