Background: In systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), due to their long term, multi-drug exposure and their side effects, non-adherence to therapy is common and is associated with adverse clinical outcome. In this study, we aimed to evaluate and compare medication adherence in patients with SLE and RA considering their psychosocial factors, health literacy, and current life concerns. Methods: 88 patients fulfilled the criteria of RA(N:46) and SLE(N:42);using disease-modifying antirheumatic drugs or immunosuppressive, we evaluated, their demographic data, co-morbid diseases, the number of medications, estimated income, having health insurance, family size and disease poor prognostic factors. The 8-item Morisky’s Medication Adherence, Depression by Beck depression inventory (21 Q), and drug literacy level were used. Results: Medication non-adherence was seen in 91.3% of the RA group and 90.4% of the SLE group. Moderate to very severe depression was seen in [21 (45.7%)] and [12 (25.9%)] of the RA and SLE patients, respectively. In the SLE group, depression and having poor prognostic factors, and in the RA group, depression, having co-morbid diseases and higher pill numbershad a significant effect on medication adherence. Conclusion: There was a high prevalence of drug non-adherence in our RA and SLE patients. The most prevalent factor in non-adherence in both groups was depression. After that, in RA patients the presence of co-morbid disease and in SLE patients the presence of poor prognostic factors were related to non-adherence. Factors like income, health insurance, disease duration, and health literacy had no significant effect on medication adherence.

Introduction: Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as a Churg-Strauss syndrome, is a rare systemic vasculitis. Central nervous system (CNS) involvement is described in rare cases. Acute spinal subdural hematoma (SSDH) is an uncommon condition presented with acute severe, radiating pain in the back area, and symptoms of spinal cord compression. The association of these two rare entities has been rarely reported so far. Case Presentation: A 32-year-old female known case of limited scleroderma for 12 years and EGPA for 6 years with presentation of eosinophilia, high P-ANCA, and skin vasculitis, was admitted to the rheumatology ward of Faghihi hospital related to Shiraz University of Medical Science in Iran (May 2016) due to new necrotizing vasculitis lesions on her hands, dyspnea, bilateral crackles, and eosinophilia. During this hospital admission, while receiving methylprednisolone, low dose aspirin, and prophylactic heparin, she developed severe upper back pain and neck rigidity and in her imaging studies, thoracic spinal subdural hematoma was seen. Conclusions: This article describes a case of EPGA presented with a non-traumatic acute subdural thoracic hematoma in addition to her classic symptoms along with limited scleroderma. This suggests that non-traumatic spontaneous acute spinal subdural hematomas should be considered in manifestations of EPGA and early recognition could be helpful for appropriate management.