Cutaneous Manifestations of Rheumatoid Vasculitis Revealing a Severe Rheumatoid Arthritis
Published: 2020-06-27
Page: 48-53
Issue: 2020 - Volume 3 [Issue 1]
Raja Amri *
Internal Medicine Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
Rabie Ayari
Plastic, Hand Surgery and Burns Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
Zaineb Alaya
Internal Medicine Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
Manel Loukil
Pulmonology Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
Monia Bousen
Emergency Department, Mongi Slim Hospital, La Marsa Tunis, Medical University of Tunis Manar, Tunisia.
Imen Chaabene
Internal Medicine Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
Abir Chaabene
Internal Medicine Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
Mohamed Ali Sbai
Plastic, Hand Surgery and Burns Department, Maamouri Hospital, Nabeul, Medical University of Tunis Manar, Tunisia.
*Author to whom correspondence should be addressed.
Abstract
Rheumatoid Arthritis (RA) is a systemic inflammatory disorder with articular and extraarticular manifestations. Rheumatoid Vasculitis (RV), an extraarticular systemic manifestation of RA, is the most serious and unusual complication of long-standing RA, associated with a poor prognosis. We report an exceptional case of rheumatoid arthritis revealed by a cutaneous manifestation of RV.
We report the case of a non-smoking 51-year-old patient with no known history, who presented with a 15-day history of a rash spreading on the legs and the palms of the hands with bilateral and symmetrical polyarthritis affecting both large and small joints, in association with an inflammatory neck pain. Physical examination revealed painful unilateral subcutaneous nodules located on the left leg and on the palms of the hands. Laboratory tests revealed an inflammatory syndrome. The diagnosis of RA revealed by cutaneous manifestations of RV was established using the ACR-EULAR 2010 classification criteria with a total score of 9. Histological examination of a subcutaneous nodule of the leg showed leukocytoclastic vasculitis associated with a polymorphic inflammatory infiltrate made mostly of neutrophils. A corticosteroid therapy of 1 mg/kg/day was initiated. The evolution was good under treatment.
The prevalence of RV has been reported to be declining, with the decrease possibly attributable to the advances in the treatment of RA. Nevertheless, this serious complication should always be considered when establishing the diagnosis of RA even in the early stages.
Keywords: Rheumatoid arthritis, rheumatoid vasculitis, cutaneous manifestation, necrotizing vasculitis, skin biopsy, corticosteroid therapy.