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A 66-year old femal with longstanding seropositive rheumatoid arthritis was admitted to the internal medicine service with bilateral foot pain and new painless raised fluid filled black lesions on her feet. Two weeks prior she underwent a right great toe amputation for "gangrene" by podiatric surgery. Five months prior, the patient discontinued all disease modifying therapies to pursue naturopathic remedies. The patient was diagnosed with rheumatoid arthritis vasculitis and despite immunosupressive therapies, the patient ultimately underwent bilateral transmetatarsal amputations for progression disease progression. This case reinforces the imporance for physicians to strongly discourage only using naturopathic remedies in rheumatoid arthritis and to consider vasculitis in any patient with rheumatoid arthritis presenting with new skin lesions as late detection can have severe implications.
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