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  #1  
Old 09-15-2011
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Question Rheumatoid Arthritis and Arterial Obstruction!

A 36‐yr‐old woman with history of 2-year rheumatoid arthritis (RA, under sulphasalazine and metotherxate treatmet) was referred to the hospital with an exacerbation of RA as well as dizziness, neck pain and headaches. Upon examination, she was found to have both swelling and tenderness in her peripheral joints, as well as a 30 loss of extension in both elbows. Neither pulses nor blood pressure were detectable in the right arm. Bruits were audible over both subclavian arteries. Laboratory results showed erythrocyte sedimentation rate (ESR) of 119 mm/h and C‐reactive protein of 16.2 mg/dl. Rheumatoid factor (RF) level was also 281 IU/ml (normal <10). Antinuclear antibodies (ANA), anti‐DNA, anti‐Ro, ‐La, ‐Sm, RNP, Scl‐70, cytoplasmic pattern antineutrophil cytoplasmic antibodies (c‐ANCA), perinuclear (p‐ANCA), protein C, S and anti‐thrombin III were negative or within normal limits. The HLA serological typing was: HLA‐A 24, 32; B 13, 44; DR 1, 4; DQ7 (Q3). A radiograph revealed peri‐articular soft‐tissue swelling and erosive changes in both hands, with a bilateral narrowing of the knee joints. Aortography showed a complete occlusion in both left and right subclavian arteries.

Rheumatoid Arthritis and Arterial Obstruction!-angiogram.jpg
click image to enlarge

What is the most likely diagnosis in this patient?

A) RA + Systemic Lupus Erythematous
B) RA + Kawasaki Disease
C) Systemic Lupus Erythematous + Kawasaki disease
D) RA + Takayasu Arteritis
E) RA + Thromboangiitis Obliterans
F) RA + Lambert-Eaton Syndrome
G) RA + Temporal Arteritis

Last edited by m82_ghasemi; 09-15-2011 at 05:18 PM.
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  #2  
Old 09-15-2011
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I go with D, takayasu.
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Old 09-15-2011
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Its D. as RA + Takasayu is pulseless, common in women.
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Old 09-15-2011
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D) RA + Takayasu Arteritis
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Old 09-15-2011
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D) RA + Takayasu Arteritis
Such a long question.. from where did u get this ques!!
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Old 09-16-2011
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D) RA + Takayasu Arteritis
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Old 09-16-2011
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Well done guys.
Actually it was a real case of RA + Takayasu in a published case report in the following link:

http://rheumatology.oxfordjournals.o...0/12/1420.full
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Old 09-16-2011
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Quote:
Originally Posted by m82_ghasemi View Post
Well done guys.
Actually it was a real case of RA + Takayasu in a published case report in the following link:

http://rheumatology.oxfordjournals.o...0/12/1420.full
Thanks for providing all the information :0
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