An elusive case of digital ischemia in a patient with Rheumatoid Arthritis

Azam, Waleed; Erum, Uzma; Muhammad, Asif Jan

doi:10.12669/pjms.344.15281

Cited by 3 publications

(2 citation statements)

References 10 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 38-year-old woman with rheumatoid arthritis showed impeding digital gangrene that led to the diagnosis of essential thrombocytosis with JAK2 mutation. The patient was treated with hydroxyurea and aspirin and platelet count progressively ameliorated; however, this improvement was not persistent, since other gangrenes on the toe and nails developed [19]. A 62-year-old woman suffering from non-erosive peripheral arthritides with general health impairment and high acute-phase reactant levels; previously, she had experienced chronic polyarthralgia and thrombocytosis discovered nine years before.…”

Section: Discussionmentioning

confidence: 99%

How to Treat Algodystrophy and Rheumatic Comorbidity in Myelofibrosis: Three Case Reports

Magazzino¹,

Urbano²,

Magnasco³

2022

Cureus

View full text Add to dashboard Cite

Algodystrophy or complex regional pain syndrome is a chronic pain condition characterized by hyperalgesia and allodynia. Patients with algodystrophy present an amplified and persistent activation of the innate immune system, with subsequent proliferation of keratinocytes and release of proinflammatory cytokines including interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α). Chronic inflammation and increased levels of cytokines are observed also in Ph-negative myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia, and primary myelofibrosis. Chronic myeloid neoplasms are characterized by overproduction of one or more mature non-lymphoid cell lineages, with erythrocytosis, thrombocytosis, and/or myeloproliferation.Three case reports described our experience in the treatment of algodystrophy and rheumatic conditions in patients with myelofibrosis; a literature search was also performed.The first patient was a 58-year-old woman who suffered from chronic myeloproliferative neoplasm in myelofibrotic evolution, under treatment with ruxolitinib and pre-treated with hydroxyurea; she reported inflammatory pain, and swelling of the tibiotarsal joints bilaterally. She was treated with neridronate 2 mg/kg for four days and methotrexate 15 mg per os per week, achieving a clinical benefit. The second patient was a 63-year-old woman diagnosed with polycythemia vera evolving to myelofibrosis. She experienced pain and swelling of the left tibiotarsal joint and difficulty walking. A therapy with low-dose steroid per os and intramuscular clodronate was administered for four months, followed by methotrexate at 15 mg per week. After two months, tenosynovitis significantly improved, as supported by the evidence of improved bone edema of the left tibiotarsal joint revealed in the magnetic resonance imaging, and pain symptoms were clinically ameliorated. The third patient was a 70-year-old male patient affected by essential thrombocythemia with myelofibrotic evolution and a paraneoplastic polymyalgia rheumatica treated with steroids and currently in remission. The patient received ruxolitinib for about two years; after the first year of treatment, he experienced pain and swelling of the right tibiotarsal joint with difficulty in walking, with a consequent diagnosis of edema and tenosynovitis, as per algodystrophy. After consulting a rheumatologist, the patient received therapy with neridronate intramuscularly with clinical benefit.As overlapping interactions and clinical manifestations between hematologic neoplasms and rheumatologic diseases exist, new clinical manifestations, such as algodystrophy, may emerge during myelofibrosis and need to be monitored in the long term by a multidisciplinary team.

show abstract

Section: Discussionmentioning

confidence: 99%

How to Treat Algodystrophy and Rheumatic Comorbidity in Myelofibrosis: Three Case Reports

Magazzino¹,

Urbano²,

Magnasco³

2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Moreover, the configuration of this phase is strongly depending on the process conditions such as sintering condition, annealing time and time of thermal processing. in this field several attempts have been made to promote the formation of the high T C phase: The accurate control of the sintering temperature and heat treatment for long periods (more than 200 hours [5][6][7], moreover synthesis atmosphere, sintering under low oxygen pressure, as well as the modification the components of a starting materials, such as, substitution for a part of Bi by combinations of Tl 0.3-x Sn x [8], part of Ca by Dy [9], part of Ca by holmium [10]. To date, an appropriate mechanism for the formation and strengthening of 2223 phase, for Bisystem as a single-phase has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Effect of Sb2O3 and/or CdO nanoparticle substitution on the properties of high-TC superconducting Bi1.6-x SbxPb0.4Sr2Ca2-yCdyCu3OZ material

Salih¹

2018

IJP

View full text Add to dashboard Cite

High temperature superconductors materials with composition Bi1.6-xSbxPb0.4Sr2Ca2-yCdyCu3OZ (x = 0, 0.1, 0.2 and 0.3) and (y = 0.01 and 0.02), were prepared by using the chemical reaction in solid-state ways, and test influence of partial replacement of Bi and Ca with Sb and Cd respectively on the superconducting properties, all samples were sintered at the same temperature (850 oC) and for the same time (195 h). The structural analysis of the prepared samples was carried out using X-ray diffraction (XRD) measurements performed at room temperature, scanning electron microscope (SEM) and dc electrical resistivity was measured as a function of temperature. It was found that the sample prepared by partial substitution of Sb at ratio (x= 0.2) and Cd with ratio (y=0.01), has the maximum value of zero resistance temperature, where was the TC(onset) and TC(0) values for this sample are (140 K) and (123 K) respectively, and XRD results reveal that this sample has the highest percentage of Bi- 2223 phase, as well as the analysis of XRD patterns of the prepared materials showed polycrystalline structure and signalize that all samples had an orthorhombic crystalline structure. It was concluded that Sb2O3 nanoparticles it may be acts as a flux agent in the matrix to lower the partial melting temperature of the samples and that leads to the promotion of the high-TC phase.

show abstract

A case in which baricitinib was effective for both rheumatoid arthritis and essential thrombocythemia

Migita

Tanaka

Tanimoto

et al. 2023

Modern Rheumatology Case Reports

View full text Add to dashboard Cite

We experienced a case of rheumatoid arthritis and JAK2V617F mutation–positive essential thrombocythemia treated with baricitinib. The patient was a 72-year-old male. He was diagnosed with rheumatoid arthritis at a local clinic in April 2018. Methotrexate (MTX) was started and the dose was increased to 16 mg/week. In October of the same year, anaemia was observed and MTX was reduced, but anaemia progressed. Blood tests showed pancytopenia, and he was referred to Rheumatology on suspicion of drug-induced pancytopenia. Pancytopenia improved with discontinuation of MTX and administration of folic acid. His platelet count was markedly increased to 1,400,000/μl at one point, decreased to 400,000/μl, and then gradually increased to 700,000–1,000,000/μl. Despite taking an antiplatelet drug, he developed cerebral infarction in June 2019. The JAK2V617F mutation was noted, and he was diagnosed with essential thrombocythemia. Hydroxycarbamide was started, but the effect was insufficient. Baricitinib, a JAK1/2 inhibitor indicated for rheumatoid arthritis, was started in August with the expectation that it would also be effective for essential thrombocythemia. The platelet count decreased to ∼400,000–600,000 cells/μl, and a decrease in the C-reactive protein level and the improvement of arthritis were noted. We report this case because it is considered to be a valuable case, suggesting that baricitinib may be effective for essential thrombocythemia.

show abstract

An elusive case of digital ischemia in a patient with Rheumatoid Arthritis

Cited by 3 publications

References 10 publications

How to Treat Algodystrophy and Rheumatic Comorbidity in Myelofibrosis: Three Case Reports

How to Treat Algodystrophy and Rheumatic Comorbidity in Myelofibrosis: Three Case Reports

Effect of Sb2O3 and/or CdO nanoparticle substitution on the properties of high-TC superconducting Bi1.6-x SbxPb0.4Sr2Ca2-yCdyCu3OZ material

A case in which baricitinib was effective for both rheumatoid arthritis and essential thrombocythemia

Contact Info

Product

Resources

About