Lymphoedema of the limbs as an extra-articular feature of rheumatoid arthritis.

Dacre, Jane; Scott, D L; Huskisson, E.C.

doi:10.1136/ard.49.9.722

Cited by 31 publications

(27 citation statements)

References 7 publications

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“…Interestingly, lymphedema predominantly affecting the upper extremities has been sporadically reported in long-standing RA [33]. However, a few cases of exclusive lower limb involvement have also been reported [34]. There is usually no correlation of lymphedema with seropositivity for rheumatoid factor or disease activity [34,35].…”

Section: Discussionmentioning

confidence: 99%

“…However, a few cases of exclusive lower limb involvement have also been reported [34]. There is usually no correlation of lymphedema with seropositivity for rheumatoid factor or disease activity [34,35]. The cause of edema in RA is currently unknown; however, immobility, inflammatory exudates around affected joints, hypoproteinemia, increased capillary permeability and filtration as well as pre-existing abnormalities of the lymphatic vessels have been discussed in this context [36,37].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease which may present with extra-articular symptoms, including cutaneous manifestations. Ulcerated rheumatoid nodules, necrotic vasculitic lesions and pyoderma gangrenosum are fairly characteristic and well-recognized causes of skin ulcers in RA. However, most RA patients develop leg ulcers due to other pathophysiological factors posing a diagnostic and therapeutic challenge and leading to considerable morbidity. Methods: A retrospective chart analysis of all patients with RA and leg ulcers hospitalized at our Dermatology Department between January 1998 and March 2008 was performed to evaluate risk factors and identify underlying conditions that predispose RA patients to the development of leg ulcers. Results: A total of 36 patients with RA and leg ulcers were identified. Three patients presented with necrotizing vasculitis and 2 with pyoderma gangrenosum. Chronic venous insufficiency was diagnosed as the underlying cause of leg ulcers in 8 patients, peripheral arterial disease in 4 patients, and combined arterial and venous malfunction in 3 patients. Five patients suffered from pressure ulcers. Interestingly, in 11 patients (31%) other underlying causes besides constricted mobility followed by secondary lymphedema could not be identified, and these ulcers were classified as ‘inactivity leg ulcers’. Conclusions: The majority of leg ulcers in patients with RA are due to underlying venous/arterial malfunction while vasculitic or traumatic ulcers are less common. Additionally, we identified a relevant subgroup of patients with ‘inactivity ulcers’ due to impaired mobility and consecutive lymphedema. Morphology and localization of ulcerations as well as duplex sonography provide the most important clues for accurate diagnosis, ensuring adequate treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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“…Because lymphedema associated with PsA and rheumatoid arthritis can be related to the inflammation process, it is important to closely follow-up these patients and to take the disease under control in patients developing lymphedema (8). Disease-modifying drugs were used in the treatment of lymphedema associated with rheumatoid diseases; however, they were inadequate most of the time (9,18). In some cases, intra-articular corticosteroid injections can result in the resolution of lymphedema in a short time (19,20).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Upper Extremity Edema in the Psoriatic Arthritis Case

Gökmen¹,

Akbal²,

Savaş³

et al. 2015

Turk J Phys Med Rehab

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Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by peripheral arthritis, enthesis, spondylitis, and psoriasis. Lymphedema arises from the slowing of lymphatic flow because of inflammatory or noninflammatory diseases such as tumors, infections, bursitis, rheumatoid arthritis, and polymyalgia rheumatica. It is commonly encountered in one or more regions of distal extremities. Lymphedema is a rare complication of PsA, and it is commonly seen asymmetrically and in lower extremities. We aimed to report a case, who followed-up with diagnosis with PsA and with complaints of upper extremity swelling and bilateral upper extremity lymphedema diagnosed as a result of the review.

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“…The results of previous studies have suggested that such oedema may be the consequence of venous obstruction, a generalised increase in capillary permeability or lymphatic obstruction [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 95%

Distal Extremity Swelling with Pitting Oedema in Rheumatoid Arthritis

Paira¹,

Caliani²,

Luraquiz³

2001

Clin Rheumatol

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Distal extremity swelling with pitting oedema due to altered lymphatic drainage has been reported in some patients with rheumatoid arthritis (RA). The resistant-to-therapy oedema usually affected the upper limbs in an asymmetrical pattern. Until now, extensor tenosynovial involvement has not been described in RA patients suffering from distal extremity swelling with pitting oedema. Three patients are described: two of them had predominant extensor tenosynovial involvement in their hands, with impaired lymphatic drainage demonstrated by (MRI) and lymphoscintigraphy, respectively. In both cases the oedema was chronic and not responsive to treatment. One patient had extensor tenosynovial involvement without impaired lymphatic drainage. In this case, the oedema remitted completely after a few days of corticosteroid therapy. None of them showed differences in serum levels of vascular endothelial growth factor (VEGF), whether they were RA patients with no pitting oedema or healthy volunteers.

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Lymphoedema of the limbs as an extra-articular feature of rheumatoid arthritis.

Cited by 31 publications

References 7 publications

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

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

Bilateral Upper Extremity Edema in the Psoriatic Arthritis Case

Distal Extremity Swelling with Pitting Oedema in Rheumatoid Arthritis

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