Vasculitis is relatively uncommon in lymphoproliferative disease and may predate the diagnosis of lymphoproliferative disease. Many vasculitides have been associated with hairy cell leukemia (HCL), including polyarteritis nodosa (PAN) and leukocytoclastic vasculitis. We herein report a case whose initial presentation was like Behçet's disease (BD) (arthritis, oral and genital ulcerations, papulopustular skin lesions) in addition to pancytopenia, but turned out to have HCL. Because of the overlap between their symptoms, like oral ulcerations, skin lesions, arthritis and constitutional findings, HCL and BD may mimic each other. We should keep in mind other reasons for vasculitis such as lymphoproliferative disease, especially whose who have hematological abnormalities such as pancytopenia.
Anxiety related to biological agents may significantly affect the patients' anxiety levels. Awareness regarding the patients' concerns and expectations related to the drug is important to ensure drug adherence and concordance to treatment.
Objective A novel inflammation-based score, C-reactive protein
(CRP)-to-albumin ratio (CAR), has been shown to have an association with the
inflammatory status in several diseases. We aimed to analyse the association
between CAR and disease activity in patients with early rheumatoid arthritis
(RA) and to determine the cut-off value of CAR in early and established RA.
Methods A total of 177 patients with RA and 111 age and gender-matched
healthy controls were included in this study. Cases with a disease duration of
less than 1 year were classified as early RA. Serum albumin, CRP, erythrocyte
sedimentation rate (ESR), Disease Activity Score-28 (DAS-28-ESR), Clinical
Disease Activity Index (CDAI) and Health Assessment Questionnaire (HAQ) scores
were recorded.
Results CAR was 2.44 (0.21–30.83) in the RA group and 0.45
(0.21–10.47) in the control group (p<0.001). Eighty-seven
(49.15%) of the RA cases were classified as early RA. The analyses
indicated that the ESR, CRP and CAR values were higher in patients with early RA
than in those with established RA and controls. CAR was correlated with albumin,
CRP, ESH, DAS-28 and HAQ scores in both early RA and established RA groups. The
receiver operating characteristic curves revealed a CAR cut-off value of 2.67
(80% sensitivity and 85% specificity) and 1.63 (77%
sensitivity and 72% specificity) for the prediction of early and
established RA, respectively.
Conclusion CAR, a formulated ratio, has been described as a predictor for
disease activity in patients with early RA as well as in those with established
RA. However, CAR has higher sensitivity and specificity for early RA than for
established RA.
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