Case for diagnosis. Subcutaneous nodules in the plantar region

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.

Reticulohistiocitosis multicéntrica en paciente con artritis reumatoidea / Multicentric reticulohistiocytosis in a patient with rheumatoid arthritis

La reticulohistiocitosis multicéntrica (RHM) es una patología sistémica, de baja prevalencia, considerada dentro delgrupo de las histiocitosis no Langerhans. Clínicamente se caracteriza por el compromiso de la piel y las articulaciones.Se describe el caso de un paciente masculino con antecedente de diagnóstico de artritis reumatoidea (AR) de 10 años de evolución, que en 2008 se presenta a la consulta por un cuadro de poliartritis asociado a prurito cutáneo,hiperpigmentación facial y presencia de múltiples lesiones nodulares rojovioláceas en codos y manos. Mediante biopsia de las lesiones cutáneas se confirma el diagnóstico de RHM. Cabe destacar que se ha descripto hasta un 30% de asociación de la entidad con patologías neoplásicas; en nuestro paciente el tamizaje fue negativo. En cuanto al tratamiento no existen protocolos avalados científicamente dada la baja incidencia de la enfermedad, por lo que sigue siendo experimental. En nuestro paciente se realizó tratamiento exitoso con metotrexate.

Multicentric reticulohistiocytosis (MRH) is a systemic pathology of low prevalence within the group of histiocytosis no-Langerhans. It is clinically characterized by the involvement of skin and joints. The present article describes the case of a male subject with a diagnosis of rheumatoid arthritis of 10 years’ duration. In 2008 he was seen in our service with multiple nodular, red skin lesions in his hands and elbows. A biopsy of the cutaneous lesions confirmed the diagnosis of MRH. An association with neoplasic disease has been described in 30% of the cases; however, in our patient cancer screening was negative. With regard to the treatment, scientifically proven protocols do not exist. This is due to the low incidence of the disease. Our patient responded well to methotrexate.

Pattern of young and elderly onset rheumatoid arthritis among a group of Egyptian patients

Rheumatoid arthritis [RA] differs depending on the age of disease onset. The differences between young onset rheumatoid arthritis [YORA] and elderly onset rheumatoid arthritis [EORA] are important because they have clinical and therapeutic implications. The study was conducted on 1185 patients who were ranked after classification according to age at onset of the disease into YORA I, 16-40 years, YORA II, 41-60 years and EORA >60 years. All were compared, based on disease duration [DD], disease activity, severity parameters and drug history. YORA I comprised 298 patients, 28.85% males, age 29.4 +/- 6 and DD 4 +/- 3.3 y, YORA II included 539 patients, 33.77% males, age 49.7 +/- 6.1 y. and DD 6.5 +/- 5.6 y. EORA included 348 RA patients 40.5% males, age 67.1 +/- 6.6 y, DD 9.95 +/- 7.2 y. Activity was increased in EORA compared to YORA I and YORA II, while severity decreased in EORA. ESR, CRP and degree of anemia were higher in EORA. RF titer was higher in YORA. In YORA peripheral joints of the hands and feet were more involved while, large joints in EORA. Rheumatoid nodules were increased in YORA I than EORA p= 0.04. Polymyalgia rheumatica was exclusively present in EORA group 25 patients 7.2%. YORA used methotrexate and its mean dose was higher than EORA. EORA on multiple DMARD 57.9% or biologics 0.8% was significantly lower compared with YORA 186.3% and 1.7%, p= 0.001. EORA has more active and less disabling and affects more males than YORA. The use of biologic therapy and combination DMARD therapy was less in EORA

Nodulose reumatóide epibulbar bilateral: relato de caso / Bilateral epibulbar rheumatoid nodulosis: case report

Apresentamos o caso de uma paciente de 64 anos, com diagnóstico de artrite reumatóide, apresentando nódulos episclerais bilaterais, sem inflamação articular ativa. A biópsia das lesões revelou presença de granulomas com células epitelióides e fibroblastos em orientação radial à zona central de degeneração necrobiótica do colágeno da episclera e esclera superficial e infiltrados de linfócitos e plasmócitos em todos os níveis da substância própria da conjuntiva. Na literatura reumatológica o desenvolvimento de nódulos reumatóides na ausência de doença articular ativa é chamado de "nodulosis rheumatoidis".

Nódulo reumatóide intermetatarsal com sintomas de neuroma de Morton: diagnóstico diferencial / Intermetatarsal rheumatoid node with Morton's neuroma signs: differential diagnosis

Paciente do sexo feminino, com 38 anos de idade, portadora de artrite reumatóide (AR), com dor intermetarsal no 3º espaco, em ambos os pés, com parestesia dos 3º e 4º dedos. Operada para resseccão de massas hipoecóicas evidenciadas por ecografia. O exame anátomo-patológico definiu degeneracão fibrinóide e mixóide (nódulo reumatóide).

¿Cuál es la definición de Rhupus? / What is the Rhupus definition?

En los últimos 30 años se han descrito cuando menos 50 casos de coexistencia de artritis reumatoide y lupus eritematoso generalizado (Rhupus), pero hasta la fecha no se han establecido parámetros claros para definir esta entidad. Esto ha llevado a confusiones y a cuestionar sí realmente existe el Rhupus. El objetivo de esta revisión es establecer las bases de la definición del Rhupus.

Nodulosis reumatoidea: un subtipo de artritis reumatoidea

Ocurrence of subcutaneous nodules in rheumatic diseases is frequent, and occasionally may be source of diagnostic confusion. These nodules are also seen in other entities such as collagen vascular diseases, metabolic and storage diseases, infections, induced by chemicals, and sometimes of unkown etiology. Subcutaneous nodules are usually asociated to systemic diseases and given its charasteristic, location, and histopathology it is possible to make a specific diagnosis. This review discusses in a minute fashion the history, histopathology, and diagnosis of subcutaneous nodules. In addition several clinical cases are reported and discussed

Granuloma anular subcutáneo / Subcutaneous annular granuloma

Se comunica un caso de granuloma anular subcutáneo en un niño de 10 años de edad. El cuadro clínico se manifiesta por múltiples nódulos subcutáneos en áreas acrales. Se menciona el antecedente de una B talasemia menor familiar, hecho no referido en la bibliografía. La ausencia de manifestaciones reumáticas, asociada a su cuadro histológico avalan el diagnóstico de G.A.S. Las lesiones persistieron durante años a pesar del tratamiento con corticoides

A mäo reumatóide e o Sinal de Raissa / The rheumatoid hand and the Signal of Raissa

O autor estuda as manifestaçoes clínico-radiológicas da mao reumatóide (MR) e acrescenta a essa rica sintomatologia o "nódulo da costureira" ou "sinal de Raissa".

Nódulo reumatóide e granuloma anular: um diagnóstico diferencial muitas vezes difícil / Rheumatoid nodule and granuloma annulare: a frequently difficult differential diagnosis

Os nódulos pseudo-reumatóides säo nódulos subcutâneous isolados, com características histológicas idênticas às do nódulo da artrite reumatóide do adulto. O granuloma anular é uma alteraçäo dermatológica acompanhada de nódulos localizados geralmente na derme, com exame anatomopatológico semelhante ao apresentado pelos nódulos pseudo-reumatóides. Descrevem-se dois casos de crianças do sexo feminino que apresentavam lesöes nodulantes na derme profunda (caso 1) e na hipoderme (caso 2), com características histológicas semelhantes. No primeiro caso, há lesöes cutâneas características de granuloma anular e, no segundo caso, o diagnóstico diferencial é discutido e difícil de ser firmado. A dificuldade em se firmar um diagnóstico nestes casos, baseando-se apenas nos dados do exame anatomopatológico, e a importância do tema justificam a presente publicaçäo