Clopidogrel-associated migratory inflammatory polyarthritis

Bibi Ayesha, Jimmy Varghese, Haraldine Stafford

Research output: Contribution to journalArticle

Abstract

Objective: Challenging differential diagnosis Background: Clopidogrel is an antiplatelet medication that plays an important role in primary management and secondary prevention of thrombotic vascular events in patients with acute coronary syndrome. It is generally well tolerated by most patients, but rare adverse effects such as inflammatory arthritis has been noted. A very few cases of migratory polyarthritis secondary to clopidogrel have been reported in the literature. Case Report: We describe 2 cases of acute migratory polyarthritis associated with clopidogrel that resolved with discontinuation of clopidogrel and did not recur after prasugrel initiation. In the first case, the patient presented with migratory polyarthritis approximately 2–3 days after initiating clopidogrel, and the symptoms lasted in each joint for 1–2 days. In the second case, the migratory polyarthritis started 1 week after initiating clopidogrel, and the symptoms lasted in each joint for approximately 2–3 days. The symptoms completely resolved after discontinuing clopidogrel in both the cases, which is typical of an immune-mediated drug reaction. A diagnosis of acute migratory inflammatory polyarthritis related to clopidogrel was determined in both cases by excluding other conditions causing inflammatory arthritis. In both cases, the eosinophil count was within normal limits, thereby differentiating the disease process from an acute allergic reaction. Conclusions: Identifying the etiology of inflammatory arthritis in a patient on clopidogrel needs extensive evaluation. The diagnosis of clopidogrel-related inflammatory arthritis is often missed due to lack of awareness. Early diagnosis and timely intervention are essential, as the symptoms completely resolve after discontinuing clopidogrel.

Original languageEnglish (US)
Pages (from-to)489-492
Number of pages4
JournalAmerican Journal of Case Reports
Volume20
DOIs
StatePublished - 2019

Keywords

  • Arthritis
  • Platelet aggregation inhibitors
  • Thienopyridines

ASJC Scopus subject areas

  • Medicine(all)

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