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Lupus anticoagulant and ischemic myocardial microangiopathy in rheumatoid arthritis

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 339–343 (2006)Cite this article

Abstract

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.

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

Diagnosis Lupus anticoagulant and ischemic myocardial microangiopathy.

Management Drug therapy with prednisolone, methotrexate, anakinra, aspirin and clopidogrel.

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Figure 1: An echocardiogram showing septal dyskinesis of the patient's left ventricle.
Figure 2: Myocardial scintigraphs showing (A) hypoperfusion of the left ventricular wall during the stress phase and (B) reperfusion of the left ventricular wall at rest.

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Authors and Affiliations

  1. GF Ferraccioli is a professor and Director of Rheumatology, A Zoli is an assistant professor, S Alivernini is a resident doctor and M De Santis is a staff member in the Rheumatology Division, A Verrillo is a staff member in the Nuclear Medicine Service and F Loperfido is an associated professor in the Cardiology Division, at the Catholic University of the Sacred Heart-Association Columbus, Rome, Italy

    Gianfranco Ferraccioli, Angelo Zoli, Stefano Alivernini, Maria De Santis, Alfonso Verrillo & Francesco Loperfido

Authors
  1. Gianfranco Ferraccioli
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  2. Angelo Zoli
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  3. Stefano Alivernini
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  4. Maria De Santis
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  5. Alfonso Verrillo
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  6. Francesco Loperfido
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Corresponding author

Correspondence to Gianfranco Ferraccioli.

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The authors declare no competing financial interests.

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Ferraccioli, G., Zoli, A., Alivernini, S. et al. Lupus anticoagulant and ischemic myocardial microangiopathy in rheumatoid arthritis. Nat Rev Cardiol 3, 339–343 (2006). https://doi.org/10.1038/ncpcardio0576

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  • DOI: https://doi.org/10.1038/ncpcardio0576

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