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Basilar occlusion syndrome is an uncommon cause of posterior circulation cerebrovascular syndromes. Approximately one-fifth of the ischemic strokes occur in the posterior cerebrovascular system and it is associated with an increased morbidity and mortality. The symptoms and signs are non-specific, resulting in delays in diagnosis, and a high index of suspicion is required that will lead to the correct diagnosis. Herein, we present a case of a 52-year-old patient who presented to the emergency department with acute onset of dizziness and vertigo due to partial thrombosis of the basilar artery. J Med Cases. 2020;11(7):221-223 doi: https://doi.org/10.14740/jmc3525

Background: Polypharmacy is a considerable problem in people with rheumatic diseases, including rheumatoid arthritis (RA), related amongst others to worse disease outcomes and increased cost for the health-system (1). Objectives: To assess polypharmacy in RA and usage of the health-care system (outpatient clinics) in a real-world setting. Methods: Medical records of 170 consecutive RA patients from a large outpatient service of a central hospital were retrospectively reviewed. Demographic characteristics, treatment for RA and comorbidities as well as frequency and type of visits to any outpatient services were recorded. The latter included rheumatologists, “medical specialties” doctors (general physicians, cardiologists, respiratory physicians, oncologists, dermatologists, gastroenterologists, hematologists, nephrologists and neurologists) and “surgical specialties” (general surgery, orthopedics, neurosurgery, urology, ophthalmology, ENT, maxillofacial and vascular surgery). Disease duration was defined as the time between RA diagnosis and the end of the study (May 2018). Univariable and multivariable analyses were performed (Table). Results: Data from 170 RA patients (77.1% female) with a mean±SD age of: 62.1 ± 13.7 years and disease duration: 87.8 ± 22.0 months, were recorded. The median number of non-rheumatic drugs receieved througouht disease duration was 3. Only 7% of the patients were not receiving any additional drugs, while 15.3%, 40.6% and 56.4% had received 1, 2 and 3 non-rheumatic drugs, respectively. The most commonly used non-rheumatic drugs were, anti-hypertensive, anti-osteoporotic and lipid-lowering drugs. Higher total number of drugs correlated with age of the patient and longer disease duration. Methotrexate (MTX) experienced or biologic-naive patinets, had received a larger number of non-rheumatic drugs compared to those who had not received methotrexate or were biologic-experienced. Multivariable analysis confirmed age and exposure to methotrexate/biologics to be positively and negatively association respectively, with the number of non-rheumatic drugs received (Table). Number of visits to rheumatologists/year were: median (range) 2.9 (0.5 – 13.6). The number of visits was correlated with age of the patients, disease duration and number of non-rheumatic drugs received. Multivariable analysis, identified, disease duration, number of non-rheumatic drugs received and being MTX-naive as predictors of number of rheumatology visits (Table). Number of visits to non-rheumatologists/year were: median (range) 1.8 (0.0 – 13.7). Visits to “internal medicine” doctors were more common than in “surgical specialties” doctors (p Conclusion: The majority of RA patients received more than 3 (non-RA related) drugs. This increased with older age and associated with more frequent visits to rheumatology and other specialties. References [1] Filkova M, et al. J Rheumatol. 2017 Dec;44:1786-1793 Disclosure of Interests: None declared

Background:Charlson Comorbidity Index[1] is a tool including age and chronic diseases assessing the comorbidity burden. The age and the comorbidity burden in RA patients determine the morbidity and mortality.Objectives:To assess and classification of CCI in RA patients with usage of the health-care system (outpatient clinics) in a real-world setting.Methods:327 patients with RA from a large outpatient service of a central hospital were retrospectively reviewed. Demographic characteristics, treatment for RA and comorbidities were recorded. Charlson Comorbidity Index (CCI) was measured and classified as low, intermediate and high score for 1-2, 3-4 and >=5 points, respectively. Its correlation with polypharmacy and necessity of biologic DMARDs was studied. Univariable and multivariable analyses were performed.Results:Data from 327 RA patients (75,8% females, 24,2%males) with a mean±SD age of 63±11,8 years and disease duration 113±63 months, were recorded.CCI was 3±1,2 points (mean±SD) and maximum score was observed at 7 points. High score (>=5points) was observed at 9,2% and in the majority the score was intermediate (3-4points) at 55%. All the RA patients with high score fulfilled the criteria of polypharmacy. Patients with high score had 9,7 times more probability of polypharmacy than the patients with low score (p=0.09, 1.4-2.5 95%CI).70 patients were treated with biologic-DMARDs (21,7%), in the majority with TNFa inhibitors (16,5%). In RA patients receiving biologic-DMARDs was observed low or intermediate score of CCI. Τhe most likely explanation is the severity of the disease that predominated, its complications and the possible overlap with other conditions.Conclusion:The majority of RA patients had intermediate score of CCI. In patients with high score-meaning more comorbidities- polypharmacy was observed completely. Patients receiving biologic-DMARDs characterized with less comorbidities.References:[1]Charlson E M et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation. J Chronic Dis. 1987;40(5):373-83.Disclosure of Interests:None declared