scholarly journals Gynecomastia in a Rheumatoid Arthritis patient: A rare side effect of Methotrexate therapy. (Preprint)

2016 ◽  
Author(s):  
Soorih Shaikh ◽  
Sarwan Shaikh
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatoid Arthritis Patient ◽  
Male Patient ◽  
Side Effect ◽  
Methotrexate Therapy ◽  
Folate Supplementation ◽  
Rare Side Effect ◽  
History Of ◽  
Male Patients

UNSTRUCTURED A 51-year-old male patient with a 3-year history of Rheumatoid Arthritis developed gynecomastia 2-3 months after starting Methotrexate therapy, without folate supplementation. Two months after stopping MTX therapy and initiating folate supplementation, gynecomastia started resolving. Very few cases of gynecomastia due to MTX therapy have been reported worldwide. Although it is a rare yet a significant occurrence and should always be considered in male patients with Rheumatoid Arthritis.

scholarly journals Clozapine-induced stuttering in the absence of known risk factors: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Florence Jaguga
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Side Effect ◽  
Case Reports ◽  
Extrapyramidal Symptoms ◽  
Prior History ◽  
Case Presentation ◽  
Rare Side Effect ◽  
History Of ◽  
Electrophysiological Findings

Abstract Background Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors. Case presentation A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms. Conclusion Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

Dermal Discoloration Secondary to Triamcinolone Acetonide Injection Observed in Patients with Autoimmune Disorders

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
James A. Wright ◽  
Jessica A. Wenz ◽  
Gabrielle Jackson Madrigal
Keyword(s):  
Psoriatic Arthritis ◽  
Side Effects ◽  
Autoimmune Disease ◽  
Triamcinolone Acetonide ◽  
Current Literature ◽  
Side Effect ◽  
Inflammatory Conditions ◽  
Rare Side Effect ◽  
History Of ◽  
Synthetic Glucocorticoid

Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.

Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis

2019 ◽  
Vol 25 (5) ◽  
pp. 197-202 ◽  
Author(s):  
Lijun Liu ◽  
Shengyun Liu ◽  
Cong Wang ◽  
Wenjuan Guan ◽  
Yinli Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Methotrexate Therapy ◽  
Folate Supplementation

scholarly journals Erectile Dysfunction as Rare Side Effect in the Simultaneous Intrathecal Application of Morphine and Clonidine

2012 ◽  
Vol 4;15 (4;8) ◽  
pp. E523-E526
Author(s):  
Gershom Koman
Keyword(s):  
Erectile Dysfunction ◽  
Pain Relief ◽  
Side Effect ◽  
Life Quality ◽  
Chronic Neuropathic Pain ◽  
Combined Application ◽  
Rare Side Effect ◽  
Provide Pain Relief ◽  
History Of ◽  
Systemic Application

We report on the case of a 52-year-old man who presented with a history of chronic neuropathic pain treated with intrathecal application of morphine for many years. In spite of significant dose escalation, considerable pain relief had not been achieved. Ziconotide had been tried but not only did it not provide pain relief, but it also caused severe side effects in this patient. A combination of morphine and clonidine was delivered by a programmable pump, slowly increasing the clonidine rate over several weeks. For ease of transition and minimization of hospitalization, which was a special concern to this patient, combining clonidine and morphine was chosen over monotherapy with hydromorphone, with both possibilities being described as equal alternatives in the literature. Considerable pain relief was achieved during week 2 at a clonidine dose of 0.040 mg/d, thereby decreasing the visual analog score (VAS) from 10 to 4. Yet, after developing erectile dysfunction and relative hypotension soon after beginning clonidine treatment, the patient decided not to continue with the combined application of morphine and clonidine. Treatment was therefore switched back to the former monotherapy with morphine. Thereafter, erectile dysfunction disappeared and blood pressure returned to habitual high levels. Although common in systemic application, erectile dysfunction caused by the intrathecal application of clonidine has not been described yet in the literature. In this patient, this rare side effect decisively impaired life quality, subjectively outweighing the considerable pain relief which could be achieved after formerly inefficacious treatment. Further and prospective investigation might be needed to estimate the connection of erectile dysfunction to intrathecal application of clonidine. Key words: intrathecal, erectile dysfunction, morphine, chronic pain, drug pump

scholarly journals Side effects of methotrexate therapy in patients with rheumatoid arthritis

2021 ◽  
Vol 7 (2) ◽  
pp. e38-e38
Author(s):  
Maryam Masoumi ◽  
Javad Balasi ◽  
Seyed Mahdi Aghamiri ◽  
Soroush Moradi ◽  
Mahbube Baghban ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Cross Sectional Study ◽  
Methotrexate Therapy ◽  
Common Disease ◽  
Duration Of Treatment ◽  
Physical Damage ◽  
Cross Sectional ◽  
Rheumatoid Arthritis Severity ◽  
History Of

Introduction: Methotrexate is widely used as the most common disease-modifying anti-rheumatoid drug (DMARD) and is known as the first line treatment for rheumatoid arthritis (RA). Objectives: To assess the side effects of methotrexate in Iranian patients with RA and to compare them with the known side effects from previous studies. Patients and Methods: We conducted a cross-sectional study of 300 patients who fulfilled the EULAR 2010 criteria of RA. The following data were recruited from patients’ profiles; age, body mass index (BMI), duration of treatment with methotrexate, initiating dose, maximum dose and current dose of methotrexate, history of fatty liver disease or hepatitis B and concomitant use of sulfasalazine, leflunomide or hydroxychloroquine. Results: In 149 out of 300 patients (49.66%), Methotrexate therapy was stopped or tapered due to side effects including nausea (23%), flu-like symptoms (8%), hepatotoxicity (12%) and hair loss (6%). The patients with hepatotoxicity had a higher duration of treatment with methotrexate (10.35 compared with 5.83; P<0.001) and also the higher initiating dose of methotrexate (12.91 compared with 12.17; P=0.010). All of the RASS (rheumatoid arthritis severity scale) indexes including disease activity, functional impairment, and physical damage are related to the presence of hepatotoxicity (P<0.001). Conclusion: Methotrexate is an excellent and effective agent for the treatment of RA and its potential side effects during the treatment are dependent on the methotrexate dosage, the level of anti-citrullinated protein antibody (ACPA) and anti-MCV antibodies and concomitant use of other drugs such as leflunomide.

Leflunomide-Associated Skin Ulceration

2002 ◽  
Vol 36 (6) ◽  
pp. 1009-1011 ◽  
Author(s):  
Christopher M McCoy
Keyword(s):  
Rheumatoid Arthritis ◽  
White Woman ◽  
Ethinyl Estradiol ◽  
Drug Effect ◽  
Methotrexate Therapy ◽  
Leg Ulcers ◽  
Skin Ulceration ◽  
Skin Breakdown ◽  
Case Summary ◽  
History Of

OBJECTIVE: To report a case of skin ulceration as a result of treatment with leflunomide for rheumatoid arthritis. CASE SUMMARY: A 78-year-old white woman developed bilateral leg ulcers after 6 months of treatment with leflunomide for rheumatoid arthritis. A history of leg ulcers after methotrexate therapy had been documented. Serologic and diagnostic tests did not support an alternate process. Other medications prescribed were oral ethinyl estradiol 0.05 mg/d, felodipine 5 mg/d, and paroxetine 20 mg/d, for which no documented correlation with the skin breakdown could be made. DISCUSSION: This is the first published case describing a possible relationship between the use of the immunosuppressant agent leflunomide and skin ulceration. CONCLUSIONS: Skin breakdown and ulceration is a recognized adverse effect of drugs with immunosuppressant activity such as methotrexate. Leflunomide, a newer agent prescribed in the treatment of rheumatoid arthritis, may now be listed among the drugs in this category associated with this adverse drug effect.

scholarly journals P036 Pyoderma gangrenosum induced by Amgevita in a seropositive rheumatoid arthritis patient: a paradoxical effect of adalimumab?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Yvonne Tan ◽  
Svetlana Kavaklieva ◽  
Fiona Wood
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatoid Arthritis Patient ◽  
Pyoderma Gangrenosum ◽  
Side Effect ◽  
Patent Protection ◽  
Paradoxical Effect ◽  
Biological Drugs ◽  
Seropositive Rheumatoid Arthritis ◽  
First Case ◽  
Tnf Α

Abstract Background/Aims  In the recent years, the outlook of management of chronic inflammatory conditions have been promising with the introduction of biological therapies. With the patent protection of original biological drugs expires, biosimilar agents are introduced in replacement of the originators, though true clinical effectiveness remains debatable. As the rare side effect profiles of the originators are slowly emerging, these occurrences are yet to be observed in the biosimilars. We present the first case reported in the literature of pyoderma gangrenosum(PG) induced by Amgevita in a seropositive rheumatoid arthritis patient. Methods  A 48-year-old gentleman had a long-standing history of seropositive rheumatoid arthritis, was commenced on Amgevita 40mg every other day in addition to his current regime of methotrexate and hydroxychloroquine in order to have better control of his disease acitivity. After 2 doses of Amgevita, he developed multiple blisters and ulcers on both of hands and the back of his neck. He denied any systemic illness and no new medication except Amgevita was initiated. He was referred urgently to the dermatologist which revealed on the dorsal aspect of hands several ulcers with fresh granulation and asymmetric border. Repeat immunology tests including vasculitis screen and bullous pemphigoid antibodies were negative. Blood and urine porphyrin screen came back negative. As skin biopsy’s findings were non-specific and inconclusive, treatment with Amgevita was reintroduced. Unfortunately, after a single dose of Amgevita, this patient developed similar ulcerations in the same distribution as previous. Amgevita was ceased immediately and patient was started a short course of steroid, which has led to complete resolution of the ulcers. Results  Following his second presentation, it was concluded that the cause for his dermatological manifestation was Amgevita. Second opinion from the dermatologists and pathologist was sought and a diagnosis of pyoderma gangrenosum induced by Amgevita was finally made. Though patient’s skin lesions recovered after the withdrawal of Amgevita, he experienced severe flares of his joints. It was clear that he required another agent to help with his disease activity. The decision to initiate Benepali, another anti-TNF agent was made and the patient had managed to tolerate it well without any side effect. Conclusion  Several recent studies have shown good therapeutic outcomes in patients with pyoderma gangrenosum treated with anti-TNF α antagonists, particularly in refractory cases. As our case proves that Amgevita can precipitate the manifestation of PG, this is suggestive that the anti-TNF α antagonist may have double-edged properties. There were very few reported cases of pyoderma gangrenosum linked to Humira, but no case of pyoderma gangrenosum induced by adalimumab-atto was known. This case highlights the paradoxical effect of anti-TNF α antagonists in PG and recognition of this association will allow the clinicians to withdraw the causative drugs promptly. Disclosure  Y. Tan: None. S. Kavaklieva: None. F. Wood: None.

Transcription regulatory polymorphism −43T>C in the 5′-flanking region of SLC19A1 gene could affect rheumatoid arthritis patient response to methotrexate therapy

2007 ◽  
Vol 27 (11) ◽  
pp. 1057-1061 ◽  
Author(s):  
Anthoula Chatzikyriakidou ◽  
Ioannis Georgiou ◽  
Paraskevi V. Voulgari ◽  
Christos G. Papadopoulos ◽  
Theodoros Tzavaras ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatoid Arthritis Patient ◽  
Methotrexate Therapy ◽  
Patient Response ◽  
Flanking Region ◽  
Regulatory Polymorphism
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