Lupus anticoagulant and ischemic myocardial microangiopathy in rheumatoid arthritis.
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.


METHODS
Laboratory analyses, electrocardiography, chest radiography, high-resolution CT, echocardiography, technetium-99m-labeled (99mTc)-methoxyisobutyl-isonitrile stress myocardial scintigraphy and coronary angiography.


METHODS
Lupus anticoagulant and ischemic myocardial microangiopathy.


RESULTS
Drug therapy with prednisolone, methotrexate, anakinra, aspirin and clopidogrel.
Ferraccioli
Gianfranco
G
Rheumatology Division, Catholic University of the Sacred Heart-Association Columbus, Rome, Italy. gf.ferraccioli@rm.unicatt.it
Zoli
Angelo
A
Alivernini
Stefano
S
De Santis
Maria
M
Verrillo
Alfonso
A
Loperfido
Francesco
F
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004452:Echocardiography; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D016682:Lupus Coagulation Inhibitor / Q000097:blood*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use; D011877:Radionuclide Imaging; D012795:Sialoglycoproteins / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D018501:Antirheumatic Agents; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D016682:Lupus Coagulation Inhibitor; D010975:Platelet Aggregation Inhibitors; D012795:Sialoglycoproteins; D011239:Prednisolone; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D008727:Methotrexate