European Journal of Rheumatology
Case Report

Severe gangrene in a patient with anti-RNP positive limited cutaneous systemic sclerosis/rheumatoid arthritis overlap syndrome caused by vasculopathy and vasculitis

1.

Department of Rheumatology, Royal Free Hospital, London, UK

2.

Department of Rheumatology, Whipps Cross University Hospital, London, UK

3.

Department of Rheumatology, The Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK

Eur J Rheumatol 2018; 5: 269-271
DOI: 10.5152/eurjrheum.2018.17177
Read: 2332 Downloads: 1059 Published: 03 September 2019

Abstract

 

In this paper, we describe a case of a male patient with anti-U1RNP positive limited cutaneous systemic sclerosis/rheumatoid arthritis overlap syndrome, who presented acutely with rapidly progressive digital ischemia, which lead to extensive gangrene. Management with conventional vasodilator therapy was unsuccessful. There were constitutional symptoms and a marked inflammatory response in the absence of evidence of infection, implying a component of vasculitis underlying the presentation. Treatment with immunosuppression and intravenous immunoglobulin led to resolution of the inflammatory process with no further progression of tissue necrosis. Here we discuss pertinent issues raised by the case, including the management of digital ischemia and gangrene in this context and the relevance of the anti-U1RNP in systemic sclerosis overlap syndromes.

 

Cite this article as: Raine C, Canning B, Marks J, Donnelly S, Ong V, Tahir H. Severe gangrene in a patient with anti-RNP positive limited cutaneous systemic sclerosis/rheumatoid arthritis overlap syndrome caused by vasculopathy and vasculitis. Eur J Rheumatol 2018; 5: 269-71.

Files
EISSN 2148-4279