Cardiovascular involvement is common in rheumatoid arthritis . Pericarditis, cardiomyopathy, myocarditis, cardiac amyloidosis, coronary vasculitis, arrhythmias, valvular heart disease and congestive heart failure due to ischemia can be seen in addition to the classical extra-articular involvement . Patients with rheumatoid arthritis are under risk of accelerated atherosclerosis and myocardial infarction due to increased inflammation. Endothelial dysfunction is an important mechanism for thrombosis in these patients . Pro-inflammatory cytokines (interleukin-1 beta and tumor necrosis factor alpha, C-reactive protein), activated coagulation factors (tissue factor, von Willebrand factor and plasminogen activator inhibitor-1), increased activity of cell adhesion molecules (selectins, vascular adhesion molecule-1, intercellular adhesion molecule-1) and matrix metalloproteinases are responsible for this endothelial dysfunction leading thrombosis . The risk is especially higher in patients who have used or are using glucocorticoids . In patients with Cushing’s syndrome due to chronic steroid use, accumulation of cardio-metabolic risk factors like visceral obesity, hypertension, hyperglycemia and hyperlipidemia results in acceleration of cardiovascular disease . Additionally, a hypercoagulability state was also detected in patients with endogenous Cushing’s syndrome . Herein we present a patient with rheumatoid arthritis who had extensive coronary thrombosis and was given steroid therapy for a long time.
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.