A 59-Year-Old Woman With Painful Rash on Her Elbows

Victoria M.F. Mank, MD; Jefferson R. Roberts, MD


August 03, 2023

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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.