Pulmonary hypertension in a patient with rheumatoid arthritis treated with leflunomide

SIR, Leflunomide (LFN) is a disease-modifying anti-rheumaticdrug that reduces the signs and symptoms of rheumatoid arthritis(RA) and delays the radiological progression of the disease[1, 2]. The most common adverse reactions leading to LFN withdrawalare gastrointestinal symptoms, skin reactions, alopecia, systemicarterial hypertension and elevated liver enzymes. Although asmall percentage of patients with RA develop systemic arterialhypertension while taking LFN, no other serious cardiovascularadverse reactions have been reported [3]. Here we report one patient with severe refractory