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Cutaneous manifestations of rheumatoid arthritis
(Case report: pyoderma gangrenosum)


Authors: K. Hviščová;  K. Pavelka
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 18, 2010, No. 3, p. 125-131.
Category: Case Report

Overview

Cutaneous manifestations in rheumatoid arthritis (RA) can be divided into two groups – nonspecific and specific. Atrophy and skin fragility, colour changes and involvement of nails belong to the nonspecific manifestations. Rheumatoid nodules and nodulosis, rheumatoid vasculitis and less frequently neutrophilic dermatosis belong to the disease-specific manifestations, as well as Sweet’s syndrome and pyoderma gangrenosum (PG). This report discusses nonspecific as well as specific cutaneous manifestations of RA with focus on neutrophilic dermatosis; a case report of pyoderma gangrenosum is also included. Recently, cases of successful treatment of PG, as a cutaneous manifestation of RA, by TNF-α blockers have been described, as well as contrary cases with occurrence of a cutaneous manifestation of RA during anti TNF-α treatment as an adverse event. Description of such a patient is reported in the end of this article.

Key words:
rheumatoid arthritis, rheumatoid nodules, rheumatoid vasculitis, neutrophilic dermatosis


Sources

1. Hochberg MC. Adult and juvenile rheumatoid arthitis: current epidemiological concepts. Epidemiol Ref 1981; 3: 27-44.

2. Alamanos Y, Voulgari PV, Drosos AA. Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin. Arthritis Rheum 2006; 36: 182-8.

3. Harris ED jr. Rheumatoid arthritis: pathophysiology and implications for therapy. N Engl J Med 1990; 322: 1277-84.

4. ĮdegĆrd S, Landewé R, van der Heijde D; Kvien TK, Mowinckel P, Uhlig T. Association of Early Radiographic Damage With Impaired Physical Function in Rheumatoid Arthritis. A Ten-Year, Longitudinal Observational Study in 238 Patients. Arthritis Rheum 2006; 54: 68-75.

5. Syversen SW, Gaarder PI, Goll GL, et al. High anti-CCP levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study. Ann Rheum Dis 2008; 67(2): 212-7.

6. Vencovsky J, Machacek S, Sedova L, et al. Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003; 62: 427-30.

7. van der Heijde DM, van Leeuwen MA, van Riel PL, van de Putte LB. Radiographic progression on radiographs of hands and feet during the first 3 years of rheumatoid arthritis measured according to Sharp’s method (van der Heijde modification). The Journal of rheumatology. 1995; 22(9): 1792-6.

8. Harris ED jr: Clinical features of rheumatoid arthritis. In: Hartus ED jr, Budd RC, Firestein GS, Genovese MC, Sergent JS, Ruddy S, Sledge CB. Kelleyęs textbook of rheumatology. 7th ed. Philadelphia: W.B. Saunders; 2005, 1055.

9. Michel C, Cribier B, Sibilia J, Kuntz Jl, Grosshans E. Nail abnormalities in rheumatoid arthritis. Br J Dematol 1997; 137: 958-62.

10. Sayah J, English JC 3rd. Rheumatoid arthritis: A rewiev of the cutaneous manifestations. J Am Acad Dermatol 2005; 53: 191-209.

11. Pavelka K, Rovenský J, Szilasiová A, et al. Revmatoidní artritida in: Klinická revmatologie. Galén 2003;181-197.

12. Levin J, Werth VP. Skin disorders with arthritis. Best Pract Res Clin Rheumatol 2006; 20: 809-26.

13. Bečvář R, Tesař V, Rychlík I. Vaskulitidy v klinické praxi – diagnostika a terapie. Medprint 1994; 111-6.

14. Pinals RS: Feltyęs syndrome. In: Harris ED jr, Budd RC, Firestein GS, Genovese MC, Sergent JS, Ruddy S, Sledge CB. Kelleyęs textbook of rheumatology. 7th ed. Philadelphia: W.B. Saunders; 2005, 1101-4.

15. Cohen PR. Neutrophilic dermatoses: a review of current treatment options. J Am Acad Dermatol 2009;10:301-12.

16. Ruocco E, Sangiuliano S, Gravina AG, Miranda A, Nicoletti G. Pyoderma gangrenosum: an update review. J Eur Acad Dermatos Venereol 2009; 23(9): 1008-1017.

17. Powell FC, Su WP, Perry HO. Pyoderma gangrenosum: clasiffication and management. J Am Acad Dermatol 1996; 34: 395-409.

18. Hasselmann DO, Bens G, Tilgen W, Reichrath J. Pyoderma gangrenosum: Clinical presentation and outcome in 18 cases and review of the literature. J Dtsch Dermatol Ges 2007; 5(7): 560-4.

19. Reichrath J, Bens G, Bonowitz A, Tilgen W. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol 2005; 53: 273-83.

20. Roy DB, Conte ET, Cohen DJ. The treatment of pyoderma gangrenosum using etanercept. J Am Acad Dermatol 2006; 54(3 Suppl 2): S128-34.

21. Brooklyn TN, Dunnill MG, Shetty A et al. Infliximab for treatment of PG: a randomised double blind placebo controlled trial. Gut 2006; 55(4): 505-9.

22. Stichenwirth M, Riedl E, Pehamberger H, Tappeiner G. Arch Dermatos 2008; 144: 817-8.

23. Disla E, Quayum B, Cuppari GG, Pancorbo R. Successful use of etanercept in a patient with pyoderma gangrenosum complicating rheumatoid arthritis. J Clin Rheumatol 2004; 10(1): 50-2.

24. Pastor N, Betlloch I, Pascual JC, Blanes M, BaĖuls J, Silvestre JF. Pyoderma gangrenosum treated with anti-TNF alpha therapy (etanercept). Clin Exp Dermatol 2006; 31(1)152-3.

25. Vandevyvere K, Luyten FP, Verschueren P, Lories R, Segaert S, Westhovens R. Pyoderma gangrenosum developing during therapy with TNF-alpha antagonists in a patient with rheumatoid arthritis. Clin Rheumatol 2007; 26: 2205-6.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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