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Osteonecrosis (ON) is a well known morbidity of several rheumatic diseases, usually affecting the hip, knee, shoulder, and ankle. The involvement of multiple or atypical sites by ON has been reported, especially in association with antiphospholipid antibodies (aPL). Rib infarction has been reported as a painful crisis of sickle cell disease, but has not been reported in rheumatic diseases. I describe here the first case of rib infarcts which developed in a patient with mixed connective tissue disease (MCTD) and secondary antiphospholipid syndrome (APS).
A 36 year old woman with hand oedema, Raynaud’s phenomenon, and polyarthritis of both hands was diagnosed as having MCTD 3 years ago. She had deep venous thromboses in both legs 2 years ago. Laboratory tests showed an antinuclear antibody titre of 1/2560, IgG anticardiolipin antibody 65.42 GPU (normal <15 GPU), and anti-U1RNP antibody (1/1280). Secondary APS associated with MCTD was diagnosed, and treatment with low dose steroid, …
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