2017 Volume 29 Issue 2 Pages 98-106
A 49-year-old woman presented to our hospital with 1-month history of acute onset pain of bilateral knees, hips and side of the chest. She was hospitalized in community hospital to investigate the cause of the pain and diagnosed with rheumatoid arthritis (RA) due to strongly positive anti-CCP antibody and findings of MRI. She was transferred to our hospital to receive treatment of RA.
On admission, she presented arthritis of the bilateral wrist, elbow and shoulder joints. She also had pain in the knees and side chest without arthritis. Laboratory examination revealed high level of D-dimer so we suspected deep vein thrombosis and pulmonary infarction, which were confirmed by ultrasound sonography and chest CT. After edoxaban 30mg was started, the pain in the knee and side of the chest was immediately improved and emboli didn’t recur. Laboratory examination revealed that enzyme activity and antigen level of protein C (PC) was reduced and mutation of PC gene was confirmed by PCR afterward. Arthritis was gradually improved by methotrexate and low dose prednisolone.
It is little reported that development of RA provoked thrombosis by PC deficiency, although both diseases are not so rare. We report this case and the relation between two diseases with a review of literature.
