After trying other medications and with improved patient compliance, this patient's disease was eventually well controlled on rituximab and leflunomide plus intermittent use of prednisone. Over the next year, she required multiple vascular surgery assessments and wound debridement, with eventual amputation below the heel. She went on to develop a similar process in the right lower extremity, requiring metatarsal amputation, eventually leading to bilateral below-knee amputation. She has also since had several fingers amputated. This case demonstrates the importance for medication compliance and the need for routine specialty care in RA.
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Cite this: Victoria M.F. Mank, Jefferson R. Roberts. A 59-Year-Old Woman With Painful Rash on Her Elbows - Medscape - Aug 03, 2023.