Abstract
Cryoglobulinemic vasculitis (CV); is a disease characterized by cryoglobulin-containing immunodeposits that often involve small vessels of the skin and glomeruli. It is considered to be a rare disorder. There are few cases identified in patients with rheumatoid arthritis (RA) suffering from immunological disorders such as Sjogren’s Disease and infectious agents such like as human immunodeficiency virus (HIV) or hepatitis C virus (HCV) infection. We wanted to share a case where we think of cryoglobulinemic vasculitis with rheumatoid arthritis at 50 years old. He applied to us with cyanosis fingertips and severe pain in his hand. Clinical features were assessed by laboratory and nailfold capillaroscopy and CV was diagnosed. Then the patient was treated with intravenous Iloprost for 5 consecutive days, nifedipin and antiagregan. Clinically, the patient presented with a significant reduction of pain and decrease of fingertips ulsers after the second monthly treatment.
Highlights
rheumatoid arthritis (RA) is a form of chronic inflammatory arthritis that progresses with marked extraarticular findings
Cryoglobulinemic vasculitis (CV) is a disease known as circulating cryoglobulin, which is characterized by the presence of skin purpura, fatigue and arthralgias
We evaluated with nailfold capilleroscopy : the capilleroscopic findings at the bazal time showing the presence of microhemorrhages, tortuosity, enlargement and derangement of capillaries and a few mega-capillaries
Summary
RA is a form of chronic inflammatory arthritis that progresses with marked extraarticular findings It can affect people of all ages and vasculitis is the rare complication of RA. CV is a disease known as circulating cryoglobulin, which is characterized by the presence of skin purpura, fatigue and arthralgias This rare disease is characterized by accumulation of different amounts in different organs and may affect the following systems that skin lesions (purpura, ulsers), peripheral neuropathy, membranoproliferative glomerulonephritis, chronic hepatitis, diffuse vasculitis and less frequently, endocrine disorders and intertitial lung involvement[2,3]. CV can be seen with some immunological and infectious diseases that RA, Primary Sjögren’s Syndrome, HCV, HIV. The incidence of rheumatoid vasculitis had declined in recent decades, it was still a disease with high morbidity and mortality despite aggressive treatment. The patient presented with a significant reduction of pain and decreased of fingertips ulcers after the second monthly treatment (Figure 2)
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