Cutaneous abnormalities in rheumatoid arthritis compared with non-inflammatory rheumatic conditions

Abstract

Background: Cutaneous abnormalities are common in rheumatoid arthritis, but exact prevalence estimates are yet to be established. Some abnormalities may be independent and coincidental, whereas others may relate to rheumatoid arthritis or its treatment. Objectives: To determine the exact nature and point prevalence of cutaneous abnormalities in patients with rheumatoid arthritis compared with those in patients with non-inflammatory rheumatic disease. Methods: 349 consecutive outpatients for rheumatology (205 with rheumatoid arthritis and 144 with noninflammatory rheumatic conditions) were examined for skin and nail signs by a dermatologist. Histories of rheumatology, dermatology, drugs and allergy were noted in detail. Results: Skin abnormalities were reported by more patients with rheumatoid arthritis (61%) than noninflammatory controls (47%). More patients with rheumatoid arthritis (39%) than controls (10%) attributed their skin abnormality to drugs. Cutaneous abnormalities observed by the dermatologist were also more common in patients with rheumatoid arthritis (76%) than in the group with non-inflammatory disease (60%). Specifically, bruising, athlete's foot, scars, rheumatoid nodules and vasculitic lesions were more common in patients with rheumatoid arthritis than in controls. The presence of bruising was predicted only by current steroid use. The presence of any other specific cutaneous abnormalities was not predicted by any of the variables assessed. In the whole group, current steroid use and having rheumatoid arthritis were the only important predictors of having any cutaneous abnormality. Conclusions: Self-reported and observed cutaneous abnormalities are more common in patients with rheumatoid arthritis than in controls with non-inflammatory disease. These include cutaneous abnormalities related to side effects of drugs or to rheumatoid arthritis itself and other abnormalities previously believed to be independent but which may be of clinical importance.

Cutaneous Adverse Events During Treatment of Chronic Inflammatory Rheumatic Conditions With Tumor Necrosis Factor Antagonists: Study Using the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases

“…We also found a lower incidence of CAE in AS and PsA patients compared with RA patients (Table ). Reports describe an increase in cutaneous lesions () and skin malignancies in RA patients () and an increase in the rate of infections, including cutaneous infections () and viral infections, especially herpesvirus (). The reason for this is not clear.…”

Leg Ulceration in Rheumatoid Arthritis – An Underreported Multicausal Complication with Considerable Morbidity: Analysis of Thirty-Six Patients and Review of the Literature

“…Systemic involvement may present with extra-articular manifestation of various organs, including the lung, heart, kidney and skin [1]. Recent studies focusing on dermatological conditions in RA patients have identified a high prevalence of rheumatoid nodules (34%) and Raynaud phenomenon (17%) [2,3,4,5]. According to different studies, the frequency of leg ulceration in patients with RA may be up to 10% [6,7] compared to the prevalence of venous leg ulceration in the general population of approximately 1% [8]; thus, implying that patients with RA are at increased risk of developing ulcerations of the lower extremities leading to considerable morbidity.…”

The Association of Rheumatoid Arthritis with Lichen Amyloidosis: Case Report

“…Indeed, in addition to the well-known specific and nonspecific cutaneous lesions, patients with RA had also been reported to exhibit a wide range of rare conditions such as dermatophytosis, erythema nodosum, alopecia, vitiligo, contact dermatitis, urticaria, tylosis, and clavus. 2,6,7 Lichen amyloidosis is a type of primary localized cutaneous amyloidosis in which amyloid, a fibrillar proteinaceous material, is deposited solely in the skin, without associated systemic involvement. 8,9 It is characterized by multiple pruritic discrete hyperkeratotic papules that coalesce into plaques, most commonly located on the anterior legs, upper back, forearms, and thighs.…”