Cutaneous Rheumatoid Vasculitis

Abstract

Rheumatoid arthritis is a multisystem disease, with many clinical forms bearing close resemblance to systemic lupus erythematosus, dermatomyositis or polyarteritis nodosa. Although the involvement of the integument is not as disabiling as the joint disease, the extent of disability may be of sufficient magnitude to necessitate therapeutic intervention. Two patients are presented whose skin involvement was suggestive of cutaneous angiitis and who responded dramatically to treatment using sulfasalazine.

Clinical and histopathological spectrum of cutaneous vasculitis in rheumatoid arthritis

“…As listed in Table 2, the histological features of cutaneous vasculitis in RA overlapped both the characteristics of cutaneous necrotizing venulitis and the characteristics of cutaneous polyarteritis nodosa. 21 Cutaneous necrotizing venulitis in RA patients with various cutaneous manifestations is well-recognized, [27][28][29][30][31][32][33][34] but cutaneous polyarteritis nodosa-like vasculitis has rarely been reported.…”

The spectrum of cutaneous lesions in rheumatoid arthritis: a clinical and pathological study of 43 patients

“…Among the reaction patterns were LCV, pustular vasculitis, folliculocentric vasculitis with sterile neutrophilic folliculitis, benign cutaneous PAN, reactive cutaneous angioendotheliomatosis, granulomatous vasculitis, and intravascular granulomatosis. Cutaneous vasculitis is associated with an adverse prognosis in patients with RA 7 …”

“…Rheumatoid arthritis characteristically affects several diarthrodial joints with a propensity to involve the small joints of the hands and feet; among the extra‐articular manifestations are skin lesions, neuropathy, pericarditis, pleuritis, interstitial pulmonary fibrosis and a systemic polyarteritis nodosa (PAN)‐like vasculitic syndrome 2 . The prototypic cutaneous lesion is the rheumatoid nodule; other manifestations have been reported either as small series or as case reports comprising such varied morphologic reaction patterns as vasculitis, rheumatoid neutrophilic dermatosis, diffuse interstitial and palisading granulomatous dermatitis and pyoderma gangrenosum 3–14 . It is apparent from these previously published works that many cutaneous lesions associated with RA in fact represent a hybrid reaction pattern such as those described by Smith et al., 11 Chu et al 12 .…”