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Hennie G. Raterman, MD; Suat Simsek, PhD, MD; Willem F. Lems, PhD, MD; Eelco W. Meesters, MD; Ben A. C. Dijkmans, MD, PhD; Michael T. Nurmohamed, PhD, MD

Arch Intern Med. 2009;169(11):1073-1074.

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Report of a Case

In August 2006, a 39-year-old woman with rheumatoid arthritis (RA) was seen at the outpatient clinic for exacerbation of RA. In the previous few months, she had progressively swollen and painful joints, notably her wrists, knees, and feet. A review of her medical history revealed that in addition to an erosive, rheumatoid factor anticitrullinated protein antibody–positive RA since 1995 she had autoimmune hypothyroidism and diabetes mellitus type 1 since 1986. For these conditions she used long-acting (24 U/d) and short-acting (50 U/d) insulin and L-thyroxine (262.5 µg/d). Findings from physical examination were unremarkable except for polyarthritis (shoulders, elbows, wrists, knees, ankles, hands, and feet). Her RA disease activity score of 28 joints (DAS28) was 8.3 (low disease status, DAS28 < 3.2). Type 1 . . . [Full Text of this Article]

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