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Gary M. White & Neil H. Cox
Diseases of the Skin


13

Collagen Vascular Disease


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RHEUMATOID ARTHRITIS

Rheumatoid arthritis is not generally the province of the dermatologist, but there are several areas where skin manifestations may be involved (Fig. 13.59, Table 13.6).

Figure 13.59

Fig. 13.59 Rheumatoid arthritis (note the joint swelling) with small skin infarcts typical of rheumatoid vasculitis; this tends to parallel disease activity in the joints.

 

Table 13.6  Some cutaneous features associated with rheumatoid arthritis
Feature
Comments
Rheumatoid ulcers
Digital lesions, splinter hemorrhages, vasculitis
Pyoderma gangrenosum
Rheumatoid neutrophilic dermatitis
Antiphospholipid syndrome
Rheumatoid nodules
Amyloidosis
Drug reactions
Due to rheumatoid vasculitis
Due to rheumatoid vasculitis (Fig. 13.59)
Relatively uncommonly associated with rheumatoid arthritis, but important therapeutically to distinguish them from vasculitic ulcers
A relatively recently documented entity
Rheumatoid arthritis is a cause
Typical nodules on the elbow rarely cause a diagnostic problem, but small nodules (sometimes termed rheumatoid nodulettes) may present at unusual sites, and disorders such as multicentric reticulohistiocytosis may be in the differential of nodules plus arthritis
If secondary type, can sometimes be diagnosed in an aspirate of subcutaneous fat
Includes urticarial and maculopapular, plus rarer conditions such as penicillamine-induced pemphigus

 

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White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.