Suffering from "rheumatoid arthritis" for 2 years, 26-year-old I almost died suddenly. Wind list is finalized.

Don't want to miss Jiemei's push? Poke the blue character "medical rheumatism and nephropathy channel" to pay attention to us, and click the "··" menu in the upper right corner, and select "set as star" to finalize the wind list. When you come to judge ~ a 26 year old male with 2-year history of rheumatoid arthritis (RA), he was admitted to hospital for acute myocardial infarction.the coronary artery disease of young patients is so serious that there is another secret behind the original case. Can you find the real culprit who has been hidden for many years? Let's challenge today's Fengbang finalization ~ case report: the patient was a 26 year old male who developed polyarthritis symptoms two years ago, including swelling and pain of hands and knees, morning stiffness, and weight loss (15kg in one year).laboratory indicators showed that ESR 73mm / h (reference value: & lt; 15mm / h), C-reactive protein 25mg / L (reference value: & lt; 5mg / h) were increased, anemia, white blood cell, lymphocyte, platelet count decreased, rheumatoid factor and anti CCP antibody were negative.consider "rheumatoid arthritis", and the symptoms improved significantly after taking NSAIDs.after that, the patient had been followed up for many times and was diagnosed as "serum negative rheumatoid arthritis".had one severe anemia during the follow-up period and received glucocorticoid treatment.three days before admission, the patient repeatedly suffered from retrosternal pain, which could radiate to both arms, accompanied by fatigue and sweating.the ECG of admission is as follows (Fig. 1). ST elevation and T wave inversion in precordial lead can be seen, indicating the recent myocardial infarction.echocardiography showed abnormal multi segmental wall motion and decreased systolic function (LVEF 35%).coronary angiography showed multiple vessel lesions (Fig. 2) and coronary artery bypass grafting (CABG).the blood vessel condition was evaluated during CABG, and the pulsation of left internal mammary artery was weakened, so we decided to use vein graft.diagram 1. ECG analysis of 2. cases of coronary angiography: young men, no hypertension, diabetes, smoking history and family history of cardiovascular disease, BMI 19kg/m2, there is no traditional cardiovascular risk factors. Although RA has a higher incidence rate of cardiovascular diseases, severe coronary artery lesions and even myocardial infarction are rare in young RA patients.the cause of myocardial infarction in patients is complicated. When people are puzzled, the patient complains that he was allergic to light, which seems to open a corner of the mystery.supplementary related immunological indexes: positive for antinuclear antibody, anti dsDNA antibody, positive for anticardiolipin antibody, positive for anti SSA and SSB; IgA 3.12iu/ml (reference value: & lt; 1 IU / ml); IgG 4.28 IU / ml (reference value: & lt; 1 IU / ml); IgM 8.07 IU / ml (reference value: & lt; 1 IU / ml). According to the 1997 classification of SLE by the American Society of Rheumatology (ACR), this patient met five criteria (photoallergy, arthritis, hematological abnormalities, immunological abnormalities, and positive antinuclear antibodies).this patient also met the six criteria of 2009 International Cooperation Group for systemic lupus erythematosus (SLICC) (clinical criteria: arthritis, leucopenia, thrombocytopenia; immunologic criteria: positive antinuclear antibody, positive anti dsDNA antibody, positive antiphospholipid antibody).in addition, according to the ACR / European Union Against Rheumatism (EULAR) SLE classification criteria in 2018, the patient score was 23.in conclusion, the patient was diagnosed as SLE on admission this time, and then received glucocorticoids, anti rheumatic drugs and anticoagulants to improve the condition. after discharge, the left ventricular systolic function improved (LVEF 50%), and no cardiovascular adverse events occurred within 2 years of follow-up. judgment experience: young patients with RA were previously diagnosed with RA, but severe coronary artery disease and blood system damage were found in this admission, so they should be reevaluated, and the previous diagnosis should be corrected after improving the examination, and finally diagnosed as SLE. this young patient had severe cardiovascular disease, but there was no traditional cardiovascular risk factor. Connective tissue disease, another potential factor of vascular disease, should be considered. let's learn something about heart involvement in SLE ~ SLE is a chronic autoimmune disease characterized by multi system involvement. any part of the heart may be affected, including myocarditis, pericarditis, conduction block, valvular disease, coronary thrombosis and pulmonary hypertension. the clinical manifestations are varied, and the pathogenesis is not clear. traditional cardiovascular risk factors can not fully explain the increased cardiovascular risk in SLE patients. some scholars believe that the increased risk of acute coronary syndrome (ACS) in SLE patients is associated with obesity, dyslipidemia, hypertension, type 2 diabetes, sedentary lifestyle, male, smoking, old age, hyperhomocysteinemia, renal insufficiency, family history of coronary heart disease and antiphospholipid antibodies. some patients may have ACS before or after SLE diagnosis. ACS in young people is relatively rare. Compared with the elderly, the etiology of young people is often more complex. Other cardiovascular risk factors and different clinical manifestations make the diagnosis more challenging. although early onset atherosclerosis is still one of the main causes of coronary artery disease in young people, other factors include non atherosclerotic coronary disease (such as congenital coronary malformation, vasculitis, myocardial bridge), hypercoagulability (such as antiphospholipid syndrome), drug abuse and alcohol abuse. may cause myocardial infarction or angina pectoris in patients with antiphospholipid syndrome, but the incidence rate of coronary heart disease is lower than that of cerebral thrombosis and deep vein thrombosis. rheumatic patients are a special high-risk group. There are many cardiovascular risk factors (such as vasculitis, secondary antiphospholipid syndrome, premature occurrence and rapid progression of atherosclerosis). RA is one of the most common rheumatic diseases. Compared with primary systemic vasculitis and SLE, the risk of cardiovascular events is relatively low. conclusion the first manifestation of this young SLE is polyarthritis and increased inflammatory indexes, and then vasculitis leads to multi vessel coronary artery disease. this case reminds us that although the patient initially met the classification criteria of RA, the rheumatoid factor and anti CCP antibody were negative, and the patient had extraarticular manifestations, and the patient had hematological involvement, photoallergy and other manifestations. Before diagnosis of RA, attention should be paid to other systemic rheumatic diseases. RA is an autoimmune disease with erosive arthritis as the main clinical manifestation. Systemic rheumatic diseases such as SLE, Sjogren's syndrome and myopathy can also be characterized by multi joint pain and swelling, but usually does not cause bone destruction. therefore, the diagnosis of serum negative RA patients should be cautious, the diagnosis needs more imaging support, and the follow-up needs close follow-up. References: [1] smiyan s, komorovsky R, tomashchuk n. acute corporate syndrome leading to revision of a co morbid condition in a young man with arthritis [J]. Reumatologia, 2019, 57 (4): 243-248. [2] Li Changhong, Liu Xiangyuan. The classification of systemic lupus erythematosus published by the European alliance against rheumatology / American Rheumatology Association in 2019 [J]. Chinese Journal of Rheumatology, 2019, 23 (12): 862-864. [3] aringer m, costenbader KH, Brinks R, Et al. Op0020 validation of new systemic lupus erythematosus classification criteria [C] / / European progress of rheumatology. 2018. [4] rheumatology branch of Chinese Medical Association. Rheumatology branch of Chinese Medical Association [J]. Chinese Journal of Rheumatology, 2010, 14 (5)