Cutaneous Manifestations of Rheumatoid Vasculitis Revealing a Severe Rheumatoid Arthritis

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.