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Inchingolo F, Inchingolo AM, Fatone MC, Avantario P, Del Vecchio G, Pezzolla C, Mancini A, Galante F, Palermo A, Inchingolo AD, Dipalma G. Management of Rheumatoid Arthritis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:662. [PMID: 38928909 PMCID: PMC11203333 DOI: 10.3390/ijerph21060662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms "rheumatoid arthritis" and "primary care" from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs' approach to the disease and patients is mandatory.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Pasquale Avantario
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gaetano Del Vecchio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Carmela Pezzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | | | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.M.I.); (P.A.); (G.D.V.); (C.P.); (A.M.); (A.D.I.); (G.D.)
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Ciofoaia EI, Pillarisetty A, Constantinescu F. Health disparities in rheumatoid arthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221137127. [PMID: 36419481 PMCID: PMC9677290 DOI: 10.1177/1759720x221137127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/12/2022] [Indexed: 10/20/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation that involves symmetric polyarthritis of small and large joints. Autoimmune rheumatic diseases represent a significant socioeconomic burden as they are among the leading causes of death and morbidity due to increased risk of cardiovascular disease. Health disparities in patients with rheumatoid arthritis affect outcomes, prognosis, and management of the disease.
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Affiliation(s)
- Elena I. Ciofoaia
- Division of Rheumatology, MedStar/Georgetown
Washington Hospital Center, Washington, DC, USA
| | - Anjani Pillarisetty
- Division of Rheumatology, MedStar/Georgetown
Washington Hospital Center, Washington, DC, USA
| | - Florina Constantinescu
- Division of Rheumatology, MedStar/Georgetown
Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010,
USA
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IbnIdris Rodwan AA, A. Mohammed AG, Adam Essa ME, Abdalla Babker AE, Mohamed Abdelsatir A, Mohammed Elagib E. Neutrophilic dermatoses in a seronegative rheumatoid arthritis patient: A case report. Clin Case Rep 2022; 10:e05249. [PMID: 35028144 PMCID: PMC8741871 DOI: 10.1002/ccr3.5249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by symmetric and destructive polyarthritis with a broad-spectrum clinical manifestation of various organs. RND is an unusual distinctive manifestation of RA and typically develops in severe RA. This report aims to present an unusual and a rare neutrophilic skin condition, in a seronegative RA Sudanese patient. A 51-year-old woman was diagnosed with RA three years ago and a history of bilateral polyarthritis, presented with a skin rash involving her extremities and abdomen. Clinical examination of her skin revealed the presence of maculopapular lesions affecting the extensor surfaces of the lower extremities and the lower part of the abdomen with hyperpigmentation. Hand X-ray demonstrated periarticular osteopenia, and laboratory and immunological studies that include C-reactive protein, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anticitrullinated peptide antibodies (ACPAs), and antinuclear factor in addition to skin biopsy were all suggested a diagnosis of neutrophilic dermatosis. The patient received steroids for the skin lesion still no significant improvement was seen, and then, cyclosporin 100 mg was administrated twice/ day with close monitoring, and two weeks later marked improvement was shown.
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Affiliation(s)
| | | | - Mohammed Elmujtba Adam Essa
- Department of Clinical MedicineMedical and Cancer Research InstituteNyalaSudan
- Faculty of MedicineAl Fashir UniversityAl FashirSudan
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Wang H. A Review of the Effects of Collagen Treatment in Clinical Studies. Polymers (Basel) 2021; 13:polym13223868. [PMID: 34833168 PMCID: PMC8620403 DOI: 10.3390/polym13223868] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Collagen, an abundant extracellular matrix protein, has been found to have a lot of pharmaceuticals, medicine, food, and cosmetics applications. Increased knowledge of collagen sources, extraction techniques, structure, and properties in the last decades has helped develop more collagen-based products and tissue engineering biomaterials. Collagen products have been playing an important role in benefiting the health of the human body, especially for aging people. In this paper, the effects of collagen treatment in different clinical studies including skin regeneration, bone defects, sarcopenia, wound healing, dental therapy, gastroesophageal reflux, osteoarthritis, and rheumatoid arthritis have been reviewed. The collagen treatments were significant in these clinical studies. In addition, the associations between these diseases were discussed. The comorbidity of these diseases might be closely related to collagen deficiency, and collagen treatment might be a good choice when a patient has more than one of these diseases, including the coronavirus disease 2019 (COVID-19). It concludes that collagen-based medication is useful in treating comorbid diseases and preventing complications.
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Affiliation(s)
- Hsiuying Wang
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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Yu X, Deng MG, Tang ZY, Zhang ZJ. Urticaria and increased risk of rheumatoid arthritis: a two-sample Mendelian randomisation study in European population. Mod Rheumatol 2021; 32:736-740. [PMID: 34918120 DOI: 10.1093/mr/roab052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/24/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND In recent years, a growing body of observational studies suggest that urticaria is associated with a higher risk of rheumatoid arthritis (RA). However, the causal association between urticaria and RA remains unknown. OBJECTIVE To investigate the causal relationship of urticaria and RA in European populations by Mendelian randomisation (MR) approach. METHODS We conducted two-sample MR analyses. Eleven single-nucleotide polymorphisms associated with urticaria were used as instrumental variables. The summary data on urticaria were derived from FinnGen Data Freeze 2. The summary data on RA were obtained from a published meta-analysis using European samples. Four MR methods were applied to the MR estimates. Three heterogeneity tests, including Cochran's Q test, single variant analysis, and leave-one-out variant analysis, were used. The pleiotropy and horizontal pleiotropy among instrumental variables were assessed with MR-Egger regression intercept, MR pleiotropy residual sum and outlier global test, and PhenoScanner. RESULTS The MR analysis suggested that urticaria was causally associated with RA (odds ratio = 1.114, 95% confidence interval = 1.024-1.211, p = .011). No genetic pleiotropy or horizontal pleiotropy was revealed by MR-Egger regression intercept and MR pleiotropy residual sum and outlier global test. The sensitivity analysis results were relatively robust. CONCLUSIONS The MR analysis suggested there was sufficient evidence to indicate urticaria is the cause of RA.
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Affiliation(s)
- Xue Yu
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, China
| | - Ming-Gang Deng
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, China
| | - Zi-Ying Tang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Zhi-Jiang Zhang
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, China
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Ha DL, Shin K, Kim HS, Ko HC, Kim BS, Kim MB. A Case of Vesicobullous Rheumatoid Neutrophilic Dermatosis. J Clin Rheumatol 2021; 27:e118-e119. [PMID: 32028303 DOI: 10.1097/rhu.0000000000001292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Hyun-Chang Ko
- From the Department of Dermatology, School of Medicine, Pusan National University
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Sánchez-Cárdenas G, Contreras-Yáñez I, Guaracha-Basáñez G, Pacheco-Santiago LD, Méndez-Flores S, Barrera-Vargas A, Merayo-Chalico J, Domínguez-Cherit J, Pascual-Ramos V. Cutaneous manifestations are frequent and diverse among patients with rheumatoid arthritis and impact their quality of life: a cross-sectional study in a cohort of patients with recent-onset disease. Clin Rheumatol 2021; 40:3581-3590. [PMID: 33651260 DOI: 10.1007/s10067-021-05664-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION/OBJECTIVES Cutaneous involvement is often overlooked in rheumatoid arthritis (RA). We described cutaneous findings in outpatients attending a recent-onset cohort and identified factors associated with skin involvement and reduced (R) dermatological quality of life (DQoL). METHODS Skin and rheumatological examinations were performed in 122 patients. DQoL was assessed through the Dermatology Life Quality Index (DLQI). Skin findings were classified as RA-specific and RA-nonspecific. Multiple regression analysis identified factors associated to skin involvement and RDQoL (DLQI score > 1). RESULTS Patients were middle-aged females (91%), with a 1-year mean disease activity score in 28 joints as 2.0 (interquartile range: 1.5-2.6). There were 94 (77%) patients in whom at least one cutaneous finding was observed: 17 (13.1%) had RA-specific findings (all were rheumatoid nodules) and 91 (96.8%) had at least one RA-nonspecific finding, further classified into skin diseases (35.2%), hair diseases (20.9%), and skin-related signs (76.9%, among whom 94.3% had xerosis). Age (odds ratio [OR]: 1.054, 95% confidence interval [CI]: 1.015-1.094) and skin-health concerns (OR: 5.657, 95% CI: 1.771-18.070) were associated with cutaneous involvement, whereas increased age and DLQI score were associated with a higher number of skin findings/patient. There were 29 patients (24.2%) with RDQoL, which were associated with the Short Form-36 emotional component (OR: 0.955, 95% CI: 0.923-0.988) and the number of skin findings/patient (OR 2.873, 95% CI 1.723-4.791). Pruritus and hair diseases were the individual categories associated with RDQoL. CONCLUSIONS Cutaneous manifestations are frequent in RA patients and have the potential to impact the emotional component of health-related quality of life. Key Points • Up to 77% of the RA patients with substantial follow-up, from a recent-onset disease cohort, had cutaneous manifestations; these were primarily RA-nonspecific findings, whereas 13.1% had RA-specific findings. • Skin-health concerns and age were associated with cutaneous involvement; meanwhile, increased age and Dermatology Life Quality Index (DLQI) score were associated with a higher number of cutaneous findings/patient. • Reduced dermatological quality of life (RDQoL) was documented in one in four patients and was associated with the SF-36 emotional component and the number of cutaneous findings/patient.
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Affiliation(s)
- Gabriela Sánchez-Cárdenas
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Lexli D Pacheco-Santiago
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Silvia Méndez-Flores
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMyN-SZ), Vasco de Quiroga 15, colonia sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, INCMyN-SZ, Vasco de Quiroga 15, colonia Sección XVI, Belisario Domínguez, Tlalpan, 14080, Mexico City, Mexico.
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8
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Case for diagnosis. Subcutaneous nodules in the plantar region. An Bras Dermatol 2020; 95:649-651. [PMID: 32622628 PMCID: PMC7562990 DOI: 10.1016/j.abd.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/09/2020] [Indexed: 11/22/2022] Open
Abstract
The authors report a case of mobile and painful nodules on the bilateral plantar surface of a female patient referred by the rheumatology service, where she was being followed-up for rheumatoid arthritis. A nodule excision was performed for differential diagnosis and symptom relief; the histopathological analysis was compatible with a rheumatoid nodule. Although rheumatoid nodules are a common manifestation of rheumatoid arthritis, exclusive plantar involvement is seldom described in the literature.
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Abstract
Rheumatoid neutrophilic dermatitis is a rare extra-articular manifestation of rheumatoid arthritis, both seropositive and seronegative for rheumatoid factor. The condition most often presents as symmetric erythematous papules, nodules, plaques, and urticaria-like lesions in patients with severe, long-lasting rheumatoid arthritis. We report a case of a 65-year-old man with well-controlled rheumatoid arthritis, who developed rheumatoid neutrophilic dermatitis on the right lower leg. The biopsy of skin lesions revealed an intense, neutrophilic dermal infiltrate, microabscesses, and leukocytoclasis without vasculitis. The patient responded well to pulses of intravenous methylprednisolone. We present this patient due to the rarity of the disease and atypical unilateral manifestation involving the flexural surfaces of the lower leg.
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10
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Fazel M, Merola JF, Kurtzman DJB. Inflammatory arthritis and crystal arthropathy: Current concepts of skin and systemic manifestations. Clin Dermatol 2018; 36:533-550. [PMID: 30047436 DOI: 10.1016/j.clindermatol.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic inflammatory disorders frequently involve the skin, and when cutaneous disease develops, such dermatologic manifestations may represent the initial sign of disease and may also provide valuable prognostic information about the underlying disorder. Familiarity with the various skin manifestations of systemic disease is therefore paramount and increases the likelihood of accurate diagnosis, which may facilitate the implementation of an appropriate treatment strategy. An improvement in quality of life and a reduction in the degree of morbidity may also be a realized benefit of accurate recognition of these skin signs. With this context in mind, this review highlights the salient clinical features and unique dermatologic manifestations of rheumatoid arthritis, adult-onset Still's disease, and the crystal arthropathy, gout.
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Affiliation(s)
- Mahdieh Fazel
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Joseph F Merola
- Division of Rheumatology and Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Drew J B Kurtzman
- Division of Dermatology, The University of Arizona College of Medicine, Tucson, Arizona, USA.
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Chua-Aguilera CJ, Möller B, Yawalkar N. Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides. Clin Rev Allergy Immunol 2017; 53:371-393. [DOI: 10.1007/s12016-017-8632-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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Ghosh SK, Bandyopadhyay D, Biswas SK, Darung I. Mucocutaneous Manifestations in Patients with Rheumatoid Arthritis: A Cross-sectional Study from Eastern India. Indian J Dermatol 2017; 62:411-417. [PMID: 28794554 PMCID: PMC5527724 DOI: 10.4103/ijd.ijd_260_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cutaneous manifestations are fairly common in rheumatoid arthritis (RA) and they can help in early diagnosis, prompt treatment, and hence reduced morbidity from the disease. AIMS The objective of the present study was to find out the different patterns of dermatoses in a group of patients with RA from Eastern India. METHODOLOGY Consecutive patients fulfilling the American Rheumatism Association 1987 revised criteria for the classification of RA and who had different dermatoses were included in this cross-sectional study done over a period of 8 years in a tertiary care hospital in Eastern India. Thorough clinical examination and appropriate laboratory investigations were performed as needed. Data were recorded in a predesigned schedule, and appropriate statistical analysis was done. RESULTS We studied 111 evaluable patients with an age range of 19-71 years and a female to male ratio of 7:1. The mean disease duration of RA was 6.5 years. Cutaneous infections as a group was the most common mucocutaneous manifestation (34.2%) followed by xerosis including ichthyotic skin changes (27%), pigmented purpuric dermatoses (14.4%), leg ulcer (9.9%), periungual telangiectasia (9.9%), rheumatoid nodules (RNs) (8.1%), purpura and ecchymoses (7.2%), small vessel vasculitis in (7.2%), corn and callosities (6.3%), palmar erythema (4.5%), and neutrophilic dermatosis (4.5%). Raynaud's phenomenon was found in 3.6% patients and panniculitis in (3.6%) patients. Rheumatoid factor (RF) and anti-cyclic citrullinated peptides antibody were positive in 74.8% and 88.3% patients, respectively. No statistically significant difference of incidence of leg ulcer, small vessel vasculitis, RN, or Raynaud's phenomenon could be noted between RF positive and negative groups. LIMITATIONS Being an institution-based study, the study findings may not reflect the true situation in the community which remained a limitation of this study. CONCLUSION While some of the features of this study were analogous to Western data, other features showed discordance which may be due to ethnic variations among the patients with RA.
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Affiliation(s)
- Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Debabrata Bandyopadhyay
- Department of Dermatology, Venereology, and Leprosy, Medical College, Kolkata, West Bengal, India
| | - Surajit Kumar Biswas
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Ivoreen Darung
- Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
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Ruangchaijatuporn T, Chang EY, Chung CB. Solitary subcutaneous sarcoidosis with massive chronic prepatellar bursal involvement. Skeletal Radiol 2016; 45:1741-1745. [PMID: 27709260 DOI: 10.1007/s00256-016-2494-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
A 56-year-old man presented with a painless prepatellar mass of the left knee. MR images demonstrated a large, well-defined mass with heterogeneous intermediate signal intensity on T1- and proton density-weighted images. Mild, heterogeneous enhancement was noted after the intravenous administration of gadolinium. Diagnostic imaging included atypical soft-tissue infection, fibrogranulomatous reaction, gouty tophus, rheumatoid nodule and xanthoma or possibly malignancy. The histopathological examination revealed sarcoidosis involving the prepatellar bursa.
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Affiliation(s)
- Thumanoon Ruangchaijatuporn
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathewi, Bangkok, Thailand, 10400.
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA.,Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, 92103, USA
| | - Christine B Chung
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA.,Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, 92103, USA
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Feldon M, Sikora K, Huggins JL, Billings SD, Mcmasters R, Brunner HI. Polyarticular Arthritis and Skin Nodulosis in a 14-Year-Old Female. Arthritis Care Res (Hoboken) 2016; 68:700-5. [DOI: 10.1002/acr.22461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/08/2014] [Accepted: 08/26/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Michal Feldon
- Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Keith Sikora
- Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
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Kellet CV, Navarrete RA, Bombardieri SG, Manriquez J. Azathioprine-induced accelerated cutaneous and pulmonary nodulosis in a patient with rheumatoid arthritis. An Bras Dermatol 2016; 90:162-4. [PMID: 26312704 PMCID: PMC4540538 DOI: 10.1590/abd1806-4841.20153750] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/22/2014] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 42-year-old female with a 5-year history of rheumatoid
arthritis treated with Rituximab and Azathioprine. Three months after the initiation
of Azathioprine, the patient started with dry cough and noted the rapid development
of multiple subcutaneous nodules on her right leg. CT scan of the chest demonstrates
pulmonary nodulosis. Skin biopsy was compatible with rheumatoid nodule. A diagnosis
of "accelerated cutaneous and pulmonary nodulosis" was considered. Azathioprine was
discontinued and Rituximab was restarted. Two months later, most of the subcutaneous
nodules had disappeared. This is the second case report of accelerated rheumatoid
nodulosis in association with Azathioprine treatment.
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Affiliation(s)
- Mónica Álvarez
- Department of Pathology, Hospital Montecelo, Pontevedra, Spain
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Benson RA, Patakas A, Conigliaro P, Rush CM, Garside P, McInnes IB, Brewer JM. Identifying the Cells Breaching Self-Tolerance in Autoimmunity. THE JOURNAL OF IMMUNOLOGY 2010; 184:6378-85. [DOI: 10.4049/jimmunol.0903951] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jung JY, Yeon JH, Ryu HS, Youn SW, Park KC, Huh CH. Disseminated superficial porokeratosis developed by immunosuppression due to rheumatoid arthritis treatment. J Dermatol 2009; 36:466-7. [PMID: 19691753 DOI: 10.1111/j.1346-8138.2009.00678.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Amini S, Baum B, Weiss E. A novel treatment for rheumatoid nodules (RN) with intralesional fluorouracil. Int J Dermatol 2009; 48:543-6. [DOI: 10.1111/j.1365-4632.2009.03894.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Xu LY, Esparza EM, Anadkat MJ, Crone KG, Brasington RD. Cutaneous manifestations of vasculitis. Semin Arthritis Rheum 2008; 38:348-60. [PMID: 18355896 DOI: 10.1016/j.semarthrit.2008.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 12/11/2007] [Accepted: 01/05/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To discuss the clinical features, diagnostic evaluation, and treatment options for cutaneous vasculitis. METHODS The literature in the PubMed database was reviewed regarding the presentation, pathophysiology, clinical workup, and treatment of cutaneous vasculitis. RESULTS Available classification criteria of vasculitis are based on histopathologic criteria or clinicohistologic features. These have been designed more for research purposes than for clinical application. Skin findings such as palpable purpura, nodules, urticaria, ulcers, and infarction are clues to the presence of vasculitis. Pathologic findings of fibrinoid necrosis, infiltration by neutrophils or lymphocytes, and deposition of complement and immunoglobulin may be helpful in reaching a specific diagnosis. However, there is considerable overlap across different conditions. CONCLUSIONS The correct diagnosis of cutaneous manifestations of vasculitis requires an understanding of vasculitis classification, recognition of specific clinical patterns, and the ability to interpret histopathologic data.
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Affiliation(s)
- Lisa Y Xu
- Rheumatology and Dermatology, Department of Internal Medicine and Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St. Louis, MO, USA
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Asarch A, Barak O, Loo DS, Gottlieb AB. Th17 cells: a new therapeutic target in inflammatory dermatoses. J DERMATOL TREAT 2008; 19:318-26. [PMID: 18626814 DOI: 10.1080/09546630802206660] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Th17 cells, named for their secretion of interleukin-17 (IL-17), are a new class of T-cells involved in a wide range of cutaneous autoimmune and inflammatory conditions. An overactive Th17 cell response in the skin can produce damaging results. There appears to be a partial role for the Th17 axis in the pathogenesis of a range of dermatological diseases including allergic contact dermatitis, atopic dermatitis, psoriasis, and scleroderma. Immunologists have also discovered a unique association between Th17 cells and cutaneous T-cell lymphoma. The Th17 branch has been linked to a number of additional systemic inflammatory diseases with significant cutaneous pathology such as systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, and Behcet's disease. Newly developed treatment modalities for neutralizing the Th17 branch of the immune system are proving to be valuable additions to the current therapeutic armamentarium.
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MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Biomarkers/metabolism
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/immunology
- Drug Therapy, Combination
- Humans
- Immunologic Factors/therapeutic use
- Injections, Subcutaneous
- Interleukin-17/genetics
- Interleukin-17/immunology
- Interleukin-23/genetics
- Interleukin-23/immunology
- Interleukins/genetics
- Interleukins/immunology
- Polymorphism, Genetic
- Psoriasis/drug therapy
- Psoriasis/immunology
- Randomized Controlled Trials as Topic
- Scleroderma, Systemic/drug therapy
- Scleroderma, Systemic/immunology
- Skin Diseases/drug therapy
- Skin Diseases/genetics
- Skin Diseases/immunology
- Treatment Outcome
- Ustekinumab
- Interleukin-22
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Affiliation(s)
- Adam Asarch
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts 02111, USA.
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