Methotrexate
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Deep vein thrombosis: case report A 39-year-old man developed deep vein thrombosis during treatment with methotrexate for rheumatoid arthritis (RA). The man presented to a physiotherapy clinic with a 4 week history of pain in upper right calf. He was a non-drinker and never smoked. His body mass index was 25.4 kg/m2. The calf symptoms occurred during a gym session, while he was exercising. Two years earlier, he was diagnosed with RA and was receiving methotrexate 20 mg/week (eight 2.5mg tablets once/week) [route not stated]. During the presentation, examination revealed that his right calf was warm, and the area of tenderness was close to popliteal crease, which was unusual. He was positive for Homans sign test, a clinical test for deep vein thrombosis. Physiotherapy assessment suggested that the actual cause of his symptoms were due to deep vein thrombosis. Therefore, he presented to a nearby accident and emergency department for evaluation. An ultrasonography of the right calf revealed deep vein thrombosis of popliteal vein. Thus, a diagnosis of deep vein thrombosis was confirmed. The man was admitted and started receiving heparin and apixaban. Later, he was discharged. He received apixaban for 6 months at a maintenance dose. It was reported that his methotrexate treatment might have also attributed for the deep vein thrombosis [duration of treatment to reaction onset and outcome not stated]. Lewis T. Patient with rheumatoid arthritis with deep vein thrombosis presenting as a calf strain: A case report. Journal of Medical Case Reports 14: 114, No. 1, 24 Jul 2020. 803499610 Available from: URL: http://doi.org/10.1186/s13256-020-02441-6
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