Unidade Local de Saúde de Coimbra.
ARP Rheumatol. 2024 Jul-Sep;3(3):240-242. doi: 10.63032/VLZL5564.
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease predominantly affecting synovial joints. Extra-articular manifestations, including skin involvement, can also occur. The most frequent cutaneous manifestation in RA patients is rheumatoid nodules, occurring in 20-30% of seropositive individuals. These nodules are typically firm, painless, and located on pressure points such as the hands and elbows. However, in a minority of cases, other skin conditions can complicate RA, notably palisaded neutrophilic granulomatous dermatitis (PNGD). PNGD presents as erythematous papules or plaques, often pruritic and distributed symmetrically over extensor surfaces, making it challenging to differentiate from rheumatoid nodules. Histopathological examination is crucial to establish the diagnosis. High clinical suspicion and appropriate referral to Dermatology are essential for accurate diagnosis and management. Treatment of PNGD is focused on underlying disease control. Other options include topical, intralesional or systemic corticosteroids, dapsone or hydroxychloroquine. Herein, we present the case of a 71-year-old woman with RA who developed PNGD, highlighting the importance of a multidisciplinary approach for achieving a favorable clinical outcome.
类风湿关节炎（RA）是一种主要影响滑膜关节的慢性系统性自身免疫性疾病。也会出现关节外表现，包括皮肤受累。RA 患者最常见的皮肤表现是类风湿结节，在 20-30%的血清阳性个体中发生。这些结节通常是坚实的、无痛的，位于手部和肘部等压力点上。然而，在少数情况下，其他皮肤状况可能使 RA 复杂化，特别是栅栏状中性粒细胞性肉芽肿性皮炎（PNGD）。PNGD 表现为红斑丘疹或斑块，常伴有瘙痒，呈对称性分布于伸肌表面，使其难以与类风湿结节区分。组织病理学检查对于确立诊断至关重要。高度的临床怀疑和适当的皮肤科转诊对于准确的诊断和管理至关重要。PNGD 的治疗侧重于基础疾病的控制。其他选择包括局部、皮损内或全身皮质类固醇、氨苯砜或羟氯喹。本文介绍了一例 71 岁女性 RA 患者发生 PNGD 的病例，强调了多学科方法对于实现良好临床结局的重要性。
