Methotrexate-Induced Cutaneous Ulcers in a Nonpsoriatic Patient: Case Report and Review of the Literature

2011 ◽  
Vol 15 (5) ◽  
pp. 275-279 ◽  
Author(s):  
Anil Kurian ◽  
Richard Haber
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Marrow ◽  
Complete Healing ◽  
Bone Marrow Suppression ◽  
Review Of The Literature ◽  
Patient Case ◽  
Antimitotic Agent ◽  
Autoimmune Conditions ◽  
History Of

Background: Methotrexate is a mainstay of treatment for autoimmune conditions such as rheumatoid arthritis and psoriasis. Methotrexate has numerous potential side effects and, in rare circumstances, can lead to cutaneous ulceration. Methotrexate can cause skin ulceration, and stopping this medication can lead to complete healing of the ulcerated lesion. Observations: A 67-year-old man with rheumatoid arthritis on long-term methotrexate therapy presented to hospital with ulcers on his hands, elbows, and lower extremities. He had no history of psoriasis. Shortly after admission, the patient was noted to have pancytopenia. A bone marrow biopsy showed a hypocellular marrow. Both the cutaneous ulcers and the hypocellular marrow were thought to be induced by methotrexate. The ulcerated areas were biopsied, and histopathology showed no evidence of vasculitis. After 1 month of rehabilitative skin care, the patient's ulcers healed almost completely and his bone marrow suppression recovered. Conclusion: We report the fifth case of methotrexate-induced cutaneous ulceration in a nonpsoriatic patient and review the literature on this unusual drug reaction. Methotrexate can induce cutaneous ulceration in nonpsoriatic patients and should be considered a potential cause of ulceration in patients treated with this antimitotic agent.

scholarly journals Rheumatoid arthritis onset after COVID-19 infection: a case report

2021 ◽  
Vol 9 (12) ◽  
pp. 3713
Author(s):  
Thafar S. A. Safar ◽  
Karmen B. Katay ◽  
Reem H. Khamis
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Pathological Condition ◽  
Primary Health Care Centre ◽  
Short Term ◽  
Health Care Centre ◽  
Immune Mediated ◽  
Small Hand ◽  
History Of

At the end of 2019, coronavirus disease (COVID-19) outbreak is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Worldwide researchers and physician try to explore the mechanisms of damage induced by virus, they focus on the short-term and long-term immune-mediated consequences induced by the virus infection. Every day discover a new pathological condition induced by virus and new symptoms and disease may occur after recovery from disease. Our case report is 41 years old, Indian lady who presented to our primary health care centre complaining of multiple small hand joints pain, both elbows and knees pain with swelling of them and prolonged morning stiffness, diagnosed seropositive rheumatoid arthritis (RA) (arthritis, positive rheumatoid factor (RF), and X-ray changes) after 1 month recovery from COVID-19 infection. She did not have any joint pain and she had negative RF before COVID-19 infection with no family history of RA.

scholarly journals Celiac Disease Diagnosed in an Older Adult Patient with a Complex Neuropsychiatric Involvement: A Case Report and Review of the Literature

2020 ◽  
Vol 10 (7) ◽  
pp. 426
Author(s):  
Emma Falato ◽  
Fioravante Capone ◽  
Federico Ranieri ◽  
Lucia Florio ◽  
Marzia Corbetto ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Case Report ◽  
Older Adult ◽  
Clinical Picture ◽  
Neurological Involvement ◽  
Extraintestinal Manifestations ◽  
Review Of The Literature ◽  
History Of ◽  
Delusional Jealousy

We present a case of celiac disease (CD) diagnosis in a 75-year-old woman with a long-term history of chronic delusional jealousy and a complex neurological involvement. The case describes a very unusual clinical picture, provides some clinical clues, and highlights the importance of being aware of CD extraintestinal manifestations in order to get a timely diagnosis.

scholarly journals Total body irradiation causes long-term mouse BM injury via induction of HSC premature senescence in an Ink4a- and Arf-independent manner

Blood ◽  
2014 ◽  
Vol 123 (20) ◽  
pp. 3105-3115 ◽  
Author(s):  
Lijian Shao ◽  
Wei Feng ◽  
Hongliang Li ◽  
David Gardner ◽  
Yi Luo ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Total Body Irradiation ◽  
Bone Marrow Suppression ◽  
Premature Senescence ◽  
Independent Manner ◽  
Telomere Shortening ◽  
Key Points ◽  
Total Body

Key Points Total body irradiation causes long-term bone marrow suppression by selectively inducing HSC senescence. The induction of HSC senescence is independent of telomere shortening and p16Ink4a and Arf.

scholarly journals Effects of Anti-TNF Alpha Drugs on Disability in Patients with Rheumatoid Arthritis: Long-Term Real-Life Data from the Lorhen Registry

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Matteo Filippini ◽  
Chiara Bazzani ◽  
Fabiola Atzeni ◽  
Piercarlo Sarzi Puttini ◽  
Antonio Marchesoni ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Marked Improvement ◽  
Real Life ◽  
Tnf Alpha ◽  
First Year ◽  
Life Data ◽  
Highly Active ◽  
Real Life Data ◽  
History Of

This study involving 1033 patients with RA confirms the effectiveness of etanercept, adalimumab, and infliximab in reducing RA-related disability even in patients with a history of highly active and longstanding RA. Moreover, we found that the improvement in disability was biphasic, with a marked improvement during the first year of anti-TNF therapy, followed by slower but significant recovery over the subsequent four years.

Clinical outcomes and patient (pt) profiles in REASSURE: An observational study of radium-223 (Ra-223) in metastatic castration-resistant prostate cancer (mCRPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 32-32
Author(s):  
Celestia S. Higano ◽  
Fred Saad ◽  
A. Oliver Sartor ◽  
Kurt Miller ◽  
Peter Conti ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Clinical Practice ◽  
Observational Study ◽  
Clinical Outcomes ◽  
Bone Fractures ◽  
Bone Marrow Suppression ◽  
Routine Clinical Practice ◽  
Metastatic Sites

32 Background: Ra-223 is a targeted alpha therapy that showed a survival advantage and favorable safety profile in the phase 3 ALSYMPCA trial in pts with mCRPC. REASSURE (NCT02141438) is evaluating the long-term safety of Ra-223 in routine clinical practice in pts with mCRPC over a 7-year follow-up period. Methods: In this global, prospective, single-arm, observational study, the second prespecified interim analysis (data cut-off March 2019) evaluated safety and clinical outcomes of Ra-223 in pts with mCRPC. Primary outcome measures were incidence of second primary malignancies (SPM), bone marrow suppression and short- and long-term safety in pts who had ≥1 Ra-223 dose. Secondary outcomes included overall survival (OS). Results: For 1465 pts in the safety analysis, median follow up was 11.5 months. Median PSA (n=1053), ALP (n=1048), and LDH (n=555) levels at baseline were 59 ng/mL, 135 U/L, and 269 U/L, respectively. 81% of pts had bone metastases only at baseline; 19% of pts had other metastatic sites, mostly in the lymph nodes. 19% of pts had <6 metastatic sites, 47% had 6–20 sites, 20% had >20 lesions but not a superscan, and 6% had a superscan. 45%, 38%, 37%, 9%, and 8% of pts received prior abiraterone, docetaxel, enzalutamide, cabazitaxel, or sipuleucel-T as prior therapies, respectively. Median number of Ra-223 doses received was 6; 67% of pts had ≥5 doses. SPM occurred in 1% of pts. The most common treatment-emergent drug-related adverse event (AE) of any grade was diarrhea (11%). 10% of pts had a bone-associated event, 5% had fractures, and 15% had a hematological AE. Median OS was 15.6 months (95% CI 14.6–16.5). Conclusions: In REASSURE, there was a low incidence of SPM, bone fractures, and bone marrow suppression after Ra-223 treatment, with no new AEs identified. This study confirms that in routine clinical practice, Ra-223 AE rates were low, and pts generally received ≥5 doses. Clinical trial information: NCT02141438. [Table: see text]

scholarly journals Fractures in Corticosteroid- and Bisphosphonate-treated Subjects With Longstanding Rheumatoid Arthritis

2021 ◽  
Author(s):  
Atie Moghtadaie ◽  
Seyed Amir Miratashi Yazd ◽  
Ahmad Salimzadeh
Keyword(s):  
Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Femoral Fractures ◽  
Bone Diseases ◽  
Multiple Fractures ◽  
Metabolic Bone Diseases ◽  
Atypical Femoral Fractures ◽  
Therapy Assessment ◽  
History Of

Background: Bisphosphonates are the most widely prescribed agents for the treatment of postmenopausal osteoporosis and other metabolic bone diseases. Atypical femoral fractures in bisphosphonate-treated patients have raised concerns regarding the long-term safety of this class of medications. Case Presentation: In this study, we report two patients suffering from fractures while receiving biphosphonates; a postmenopausal patient with rheumatoid arthritis and a history of long-term use of bisphosphonates and glucocorticoids presenting with multiple fractures as case one and another 52-year-old female patient diagnosed with Systemic Lupus Erythematosus (SLE) who suffered from a femoral shaft fracture without any history of prior traumatic incidents as case two. Conclusions: Considering the low risk for atypical femoral fractures, further careful screening for these types of fractures should be undertaken. In addition, in order to lower the rate of fractures in patients on long-term bisphosphonate therapy, assessment of patients’ contralateral side should be considered to prevent further fractures, especially in patients with prodromal pain.

scholarly journals Risk factors of hippocampal sclerosis in the oldest old

Neurology ◽  
2018 ◽  
Vol 91 (19) ◽  
pp. e1788-e1798 ◽  
Author(s):  
Thomas Trieu ◽  
Seyed Ahmad Sajjadi ◽  
Claudia H. Kawas ◽  
Peter T. Nelson ◽  
María M. Corrada
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Thyroid Disease ◽  
Hippocampal Sclerosis ◽  
Oldest Old ◽  
Lewy Body Disease ◽  
Thyroid Stimulating Hormone ◽  
Autoimmune Conditions ◽  
Potential Risk Factors ◽  
History Of

ObjectiveTo examine the risk factors and comorbidities of hippocampal sclerosis (HS) in the oldest-old.MethodsA total of 134 participants with dementia from The 90+ Study with longitudinal evaluations and autopsy were included in this investigation. Participants were divided into 2 groups, one with and one without HS pathology, and differences in clinical and pathologic characteristics were compared.ResultsPersons with HS tended to have a longer duration of dementia compared to participants without HS (mean 4.0 years vs 6.7 years, odds ratio [OR] 1.26; 95% confidence interval [CI] 1.11–1.42; p < 0.001). HS was more likely in participants with a history of autoimmune diseases (rheumatoid arthritis or thyroid disease, OR 3.15; 95% CI 1.30–7.62; p = 0.011), high thyroid-stimulating hormone (OR 4.94; 95% CI 1.40–17.46; p = 0.013), or high thyroid antibodies (OR 3.45; 95% CI 1.09–10.88; p = 0.035). Lewy body disease (LBD) pathology was also associated with an increased likelihood of HS (OR 5.70; 95% CI 1.22–26.4; p = 0.027).ConclusionWe identified autoimmune conditions (rheumatoid arthritis and thyroid disease) as potential risk factors for HS in our cohort. LBD was the only pathology that was associated with increased odds of HS and those harboring HS pathology had a longer duration of dementia. This suggests multiple pathways of HS pathology among the oldest-old.

scholarly journals Temozolomide induced bone marrow Suppression-A single institution outcome analysis and review of the literature

2015 ◽  
Vol 90 (9) ◽  
pp. E183-E184 ◽  
Author(s):  
Taxiarchis V. Kourelis ◽  
Jan C. Buckner ◽  
Naseema Gangat ◽  
Mrinal M. Patnaik
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Suppression ◽  
Outcome Analysis ◽  
Review Of The Literature ◽  
Single Institution
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