Introduction: Rheumatoid arthritis is associated with an enhanced morbidity & mortality from cardiovascular disease and this may be related to an atherogenic lipid profile. Dyslipidemia is influenced by the disease activity of rheumatoid arthritis. The aim of the study is to describe the impact of rheumatoid arthritis (RA) on lipoprotein levels with potential implication for atherosclerosis.Method: 150 patients of rheumatoid arthritis, both male & female, were selected for this study and changes in their lipid profile were measured by enzymatic methods.Results: Patients with RA face an increased risk of developing premature cardiovascular disease and limited ability to modify risk factors e.g. through exercise. RA is associated with an abnormal lipoprotein pattern, principally low levels of high density lipoprotein (HDL-C) cholesterol. Most treatments for RA tend to improve the atherogenic index (total/HDL cholesterol ratio), with more evidence for biologics in this regard. The improvement in the lipoprotein profile in RA appears to be associated with suppression of inflammation.Conclusions: Lipid levels should be monitored and managed in patients with RA to minimize the long-term risk of cardiovascular disease. More research is needed to quantify the relationship between systemic inflammation and lipoprotein levels and to determine the impact of specific lipoprotein particles, e.g., small dense low-density lipoprotein and sub fractions of HDL on long-term risk. Control of inflammation may have an effect on modifying cardiovascular risk.

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Adrenal crisis is a rare life-threatening medical endocrine emergency with non-specific insidious symptoms and challenging diagnosis. An appropriate timely diagnosis and treatment can save life. Although most doctors are educated by “sick day rules,” but are reluctant to start glucocorticoids, increase doses or switch to parental injections. Our case report highlights various aspect of adrenal crisis.

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