Case Report
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Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report

Year 2020, Volume: 7 Issue: 2, 103 - 105, 31.08.2020

Abstract

The risk factors of stroke in young population are associated with large or small vessel diseases, cardiac diseases, hematologic disorders and genetic disorders. Rheumatologic disorders such as rheumatoid arthritis may also be associated with increased stroke risk. Furthermore, non steroid anti-inflammatory drugs and steroids which are widely used for the medication of these disorders may contribute to risk of stroke. In this paper, a 44 years old female patient with stroke and comorbid rheumatoid arthritis who has additional stroke risk factors including methyl tetrahydrofolate reductase gene mutation, low vitamin B12 level, tromobocytosis and methotrexate therapy was investigated.

References

  • Kes VB, Zavoreo I, Demarin V. Etiology and diagnostic work-up in in young stroke patients. Periodicum Biologorum. 2012;114(3):355-9.
  • Wolfe F, Michaud K. Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am J Med. 2004;116(5):305–11.
  • Toyoda K, Uwatoko T, Shimada T, et al. Recurrent small-artery disease in hyperhomocysteinemia: widowers’ stroke syndrome? Intern Med. 2004;43(9):869-72.
  • Goyette P, Sumner JS, Milos R, et al. Human methylenetetrahydrofolate reductase: isolation of cDNA, mapping and mutation identification. Nat Genet. 1994;7(2): 195-200.
  • Frosst P, Blom HJ, Milos R, et al. A candidate genetic risk factor for vascular disease: a common mutation in methylenetetrahydrofolate reductase. Nat Genet. 1995;10(1):111-3.
  • Somarajan BI, Kalita J, Mittal B, Misra UK. Evaluation of MTHFR C677T polymorphism in ischemic and hemorrhagic stroke patients. A case-control study in a Northern Indian population. J Neurol Sci. 2011;304(1-2): 67-70.
  • Huang YC, Chang SJ, Chiu YT, Chang HH, Cheng CH. The status of plasma homocysteine and related B-vitamins in healthy young vegetarians and nonvegetarians. Eur J Nutr. 2003;42(2):84–90.
  • Refsum H, Helland S, Ueland PM. Fasting plasma homocysteine as a sensitive parameter of antifolate effect:A study of psoriasis patients receiving low dose methotrexate treatment. Clin Pharmacol Ther. 1989;46(5):510-20.
  • Morgan SL, Baggot JE, Vaughn WH, et al. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis. Arthritis Rheum. 1990;33(1):9-18.
  • Sandercock PAG, Warlow CP, Jones LN, Starkey IR. Predisposing factors for cerebral infarction: the Oxfordshire Community Stroke Project. Br Med J. 1989;298(6666):75-80.
  • Ross Russell RW, Wade JPH. Haematological causes of cerebrovascular disease. In: Toole JF, ed. Handbook of Clinical Neurology: Vascular Diseases. Amsterdam, Netherlands: Elsevier Science Publishers BV; 1989:463-81.
  • Holmqvist ME, Klareskog L, Alfredsson L, Askling J. Stroke in rheumatoid arthritis: (when) is there an increased risk? Ann Rheum Dis. 2010;69(3):109.
  • Nadareishvili Z, Michaud K, Hallenbeck JM, Wolfe F. Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: a nested, case-control study. Arthritis Rheum. 2008;59(8):1090–6.
  • Hallenbeck JM. The many faces of tumor necrosis factor in stroke. Nat Med. 2002;8(12):1363–8.
  • Low ASL, Lunt M, Mercer LK, et al. Association between ıschemic stroke and tumor necrosis factor ınhibitor therapy in patients with rheumatoid arthritis. Arthritis & Rheumatol. 2016:68(6);1337–45.
  • Lindhardesen J, Ahlehoff O, Gislason GH, et al. Risk of atrial fibrillation and stroke in patients with rheumatoid arthritis: Danish nationwide cohort study. BMJ. 2012;8;344:e1257
  • Bowman TS, Gaziano JM, Kase CS, Sesso HD, Kurth T. Blood pressure measures and risk of total, ischemic, and hemorrhagic stroke in men. Neurology. 2006;67(5):820–3.
  • Solomon DH, Avorn J, Katz JN, et al. Immunosuppressive medications and hospitalization for cardiovascular events in patients with rheumatoid arthritis. Arthritis Rheum. 2006;54(12):3790–8.

Romatoid Artritli Bir Hastada Multipl Risk Faktörleri Sebebiyle Oluşan Genç İnme: Olgu Sunumu

Year 2020, Volume: 7 Issue: 2, 103 - 105, 31.08.2020

Abstract

Genç hastalarda inme ile ilgili risk faktörleri küçük ya da büyük damar hastalıkları, kalp hastalıkları, hematolojik ve genetik bozukluklardır. Romatoid artrit gibi romatolojik hastalıklar da ayrıca artmış inme riski ile ilişkili olabilir. Buna ek olarak, bu hastalıklarda sıklıkla kullanılan non-steroid antiinflamatuar ilaçlar ve steroidler de inme risk faktörleri arasında sayılabilir. Bu vakada, komorbid romatoid artrite ek olarak metil tetrahidrofolat reduktaz gen mutasyonu, düşük B12 vitamin seviyesi, trombositoz ve metotreksat tedavisi gibi ek inme risk faktörleri olan 44 yaşında inmeli kadın hasta sunulmuştur.

References

  • Kes VB, Zavoreo I, Demarin V. Etiology and diagnostic work-up in in young stroke patients. Periodicum Biologorum. 2012;114(3):355-9.
  • Wolfe F, Michaud K. Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am J Med. 2004;116(5):305–11.
  • Toyoda K, Uwatoko T, Shimada T, et al. Recurrent small-artery disease in hyperhomocysteinemia: widowers’ stroke syndrome? Intern Med. 2004;43(9):869-72.
  • Goyette P, Sumner JS, Milos R, et al. Human methylenetetrahydrofolate reductase: isolation of cDNA, mapping and mutation identification. Nat Genet. 1994;7(2): 195-200.
  • Frosst P, Blom HJ, Milos R, et al. A candidate genetic risk factor for vascular disease: a common mutation in methylenetetrahydrofolate reductase. Nat Genet. 1995;10(1):111-3.
  • Somarajan BI, Kalita J, Mittal B, Misra UK. Evaluation of MTHFR C677T polymorphism in ischemic and hemorrhagic stroke patients. A case-control study in a Northern Indian population. J Neurol Sci. 2011;304(1-2): 67-70.
  • Huang YC, Chang SJ, Chiu YT, Chang HH, Cheng CH. The status of plasma homocysteine and related B-vitamins in healthy young vegetarians and nonvegetarians. Eur J Nutr. 2003;42(2):84–90.
  • Refsum H, Helland S, Ueland PM. Fasting plasma homocysteine as a sensitive parameter of antifolate effect:A study of psoriasis patients receiving low dose methotrexate treatment. Clin Pharmacol Ther. 1989;46(5):510-20.
  • Morgan SL, Baggot JE, Vaughn WH, et al. The effect of folic acid supplementation on the toxicity of low-dose methotrexate in patients with rheumatoid arthritis. Arthritis Rheum. 1990;33(1):9-18.
  • Sandercock PAG, Warlow CP, Jones LN, Starkey IR. Predisposing factors for cerebral infarction: the Oxfordshire Community Stroke Project. Br Med J. 1989;298(6666):75-80.
  • Ross Russell RW, Wade JPH. Haematological causes of cerebrovascular disease. In: Toole JF, ed. Handbook of Clinical Neurology: Vascular Diseases. Amsterdam, Netherlands: Elsevier Science Publishers BV; 1989:463-81.
  • Holmqvist ME, Klareskog L, Alfredsson L, Askling J. Stroke in rheumatoid arthritis: (when) is there an increased risk? Ann Rheum Dis. 2010;69(3):109.
  • Nadareishvili Z, Michaud K, Hallenbeck JM, Wolfe F. Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: a nested, case-control study. Arthritis Rheum. 2008;59(8):1090–6.
  • Hallenbeck JM. The many faces of tumor necrosis factor in stroke. Nat Med. 2002;8(12):1363–8.
  • Low ASL, Lunt M, Mercer LK, et al. Association between ıschemic stroke and tumor necrosis factor ınhibitor therapy in patients with rheumatoid arthritis. Arthritis & Rheumatol. 2016:68(6);1337–45.
  • Lindhardesen J, Ahlehoff O, Gislason GH, et al. Risk of atrial fibrillation and stroke in patients with rheumatoid arthritis: Danish nationwide cohort study. BMJ. 2012;8;344:e1257
  • Bowman TS, Gaziano JM, Kase CS, Sesso HD, Kurth T. Blood pressure measures and risk of total, ischemic, and hemorrhagic stroke in men. Neurology. 2006;67(5):820–3.
  • Solomon DH, Avorn J, Katz JN, et al. Immunosuppressive medications and hospitalization for cardiovascular events in patients with rheumatoid arthritis. Arthritis Rheum. 2006;54(12):3790–8.
There are 18 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Case Report
Authors

Berke Aras 0000-0002-2761-3478

Volkan Yılmaz This is me 0000-0002-8937-6527

Fatma Avşar Ertürk This is me 0000-0001-7576-1902

Publication Date August 31, 2020
Submission Date March 21, 2019
Published in Issue Year 2020 Volume: 7 Issue: 2

Cite

APA Aras, B., Yılmaz, V., & Avşar Ertürk, F. (2020). Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 7(2), 103-105.
AMA Aras B, Yılmaz V, Avşar Ertürk F. Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report. MMJ. August 2020;7(2):103-105.
Chicago Aras, Berke, Volkan Yılmaz, and Fatma Avşar Ertürk. “Young Stroke Due to Multiple Risk Factors in a Patient With Rheumotoid Arthritis: A Case Report”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 7, no. 2 (August 2020): 103-5.
EndNote Aras B, Yılmaz V, Avşar Ertürk F (August 1, 2020) Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 7 2 103–105.
IEEE B. Aras, V. Yılmaz, and F. Avşar Ertürk, “Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report”, MMJ, vol. 7, no. 2, pp. 103–105, 2020.
ISNAD Aras, Berke et al. “Young Stroke Due to Multiple Risk Factors in a Patient With Rheumotoid Arthritis: A Case Report”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 7/2 (August 2020), 103-105.
JAMA Aras B, Yılmaz V, Avşar Ertürk F. Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report. MMJ. 2020;7:103–105.
MLA Aras, Berke et al. “Young Stroke Due to Multiple Risk Factors in a Patient With Rheumotoid Arthritis: A Case Report”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, vol. 7, no. 2, 2020, pp. 103-5.
Vancouver Aras B, Yılmaz V, Avşar Ertürk F. Young Stroke due to Multiple Risk Factors in a Patient with Rheumotoid Arthritis: A Case Report. MMJ. 2020;7(2):103-5.