Rheumatoid Vasculitis Following Change to Naturopathic Remedies

Main Article Content

Graeme Prosperi-Porta
Ben John Wilson

Abstract

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. 

Abstract 111 | pdf Downloads 45 HTML Downloads 61

References

1. Bartels CM, Bridges AJ. Rheumatoid vasculitis: Vanishing menace or target for new treatments? Curr Rheumatol Rep. 2010;12(6):414–19. http://dx.doi. org/10.1007/s11926-010-0130-1
2. Turesson C, Jacobsson LT, Sturfelt G, Matteson EL, Mathsson L, Ronnelid J. Rheumatoid factor and antibodies to cyclic citrullinated peptides are associated with severe extra-articular manifestations in rheumatoid arthritis. Ann Rheum Dis. 2007;66(1):59–64. http://dx.doi.org/10.1136/ ard.2006.054445
3. Ntatsaki E, Mooney J, Scott DG, Watts RA. Systemic rheumatoid vasculitis in the era of modern immunosuppressive therapy. Rheumatology (Oxford). 2014;53(1):145–52. http://dx.doi.org/10.1093/rheumatology/ket326
4. Singh JA, Saag KG, Bridges SL, Jr., Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2016;68(1):1–25. http:// dx.doi.org/10.1002/acr.22783