Usefulness of the ankle-brachial index as a survey method for subclinical vascular disease in patients with rheumatoid arthritis.

REhearing to baseline (determined through anewaudiometry) and normalization of acute phase reactants. The patientwas discharged with prednisone 30mg/day and tapered the dosage of MTX to 12.5mg/week, remaining asymptomatic after 6 months. Since the first description of CS,more than 220 cases have been described, 92 of themappearingatypically.5 Unlike typical CS, theatypical variety is most commonly associated with systemic6 manifestations and otherautoimmunediseases, suchas sarcoidosis, rheumatoidarthritis, relapsing polychondritis, juvenile idiopathic arthritis, Sjögren’s syndrome and inflammatory bowel disease, among others.7 Our case may raise doubts about the diagnosis, given the coexistence of several autoimmune8,9 diseases. Psoriatic arthropathy could justify that the patient presented uveitis. Relapsing polychondritis can also presentwith hearing loss and vertigo, although generally it is a conductive hearing loss and vestibular dysfunction is not as similar to Meniere’s. In this patient, the vestibular episodes were intense, with prolonged and bilateral sensorineural hearing loss, preceded by ocular involvement in less than a two year interval, and in the absence of specific complementary data, made us opt for the diagnosis of atypical CS, fulfilling the criteria established by Haynes et al.,3 with 2 associated autoimmune disorders (psoriatic arthritis and relapsing polychondritis) and showing a good response to corticosteroid and immunosuppressive therapy, something relevant given the poor prognosis of deafness.