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Case 38 

Case 38
Case 38

Joel David

, Anne Miller

, Anushka Soni

, and Lyn Williamson

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date: 23 October 2019

A 69-year-old woman with a 15-year history of seropositive rheumatoid arthritis (RA) presented with increasing neck pain and arm weakness. Over the preceding 9 months, she had experienced bilateral numbness and paraesthesia in her hands, suggestive of bilateral carpal tunnel syndrome. She denied lower-limb weakness or bowel or bladder disturbance. Her RA was treated with methotrexate and certolizumab, a pegylated anti-TNF-α‎ monoclonal antibody. She had previously used many DMARDs, including hydroxychloroquine, sulfasalazine, gold, and ciclosporin, which had been ineffective in controlling her disease. In the past, she had undergone arthroplasty of her left shoulder, left knee, right hip, and bilateral forefoot.

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