Publication:

Aetiopathogenesis of ischemic stroke in rheumatoid arthritis: a case series study from tertiary care centre of South India

Stroke is a major health concern worldwide. Published meta-analyses showed significant higher risk of ischemic and hemorrhagic stroke in patients with rheumatoid arthritis (RA) compared to the general population. Major etiopathogenesis of ischemic stroke in RA is non-atherosclerotic vasculopathy. Here the authors described varied aetiopathogensis of ischemic stroke in patients with RA which had been seldom reported in the literature. It was one of the first case series which threw light in this genre. Observational, prospective case series study was conducted over a period of one year. Amongst four cases presenting as an ischemic stroke with co-existing RA; each patient had a medium or small vessel vasculopathy, which had never been described earlier. Case 1 had cardio embolic source plus large vessel vasculopathy, case 2 had intracranial non-atherosclerosis vasculopathy; case 3 had secondary Moya-Moya disease; case 4 had both intracranial and extra cranial vasculopathy. Underlying aetiopathogensis of stroke in patients with RA can be attributed to insufficient cardiovascular treatment (well described in the literature) and vasculopathy of extracranial and intracranial vessels and secondary Moyamoya disease due to RA. Thorough evaluation is needed to prevent recurrence of stroke. The treatment strategy in these patients are immunotherapy apart from the conventional therapy with antiplatelet and statins.