Nishikawa J A
Eur J Rheumatol Inflamm. 1983;6(3):288-90.
Five patients with severe rheumatoid arthritis are reported in whom leg ulcers were not apparently associated with vasculitis. The conventional explanation for these ulcers deserves review. Patients with rheumatoid arthritis may develop 'gravitational' leg ulceration and pressure sores on their legs. In addition, they may develop ulcers on the lower aspects of the legs and around the ankles which are well demarcated, punched out, painful and slow to heal. These ulcers usually occur in patients with longstanding, severe, seropositive disease. They are presently considered to be due to a necrotising arteritis causing dermal infarction, since they are frequently associated with other clinical features of rheumatoid vasculitis. Wilkinson has commented that 'biopsies are seldom taken from leg ulcers'. In this paper we report five patients with severe rheumatoid arthritis who developed such leg ulcers in the absence of other clinical evidence of vasculitis and in whom biopsies of the ulcers failed to reveal vasculitis. A case is summarised as illustrative of the five patients, whose relevant histories, clinical findings, and laboratory investigations are summarised in Table 1.
报告了5例严重类风湿性关节炎患者，其腿部溃疡显然与血管炎无关。对这些溃疡的传统解释值得审视。类风湿性关节炎患者可能会出现腿部“重力性”溃疡和压疮。此外，他们可能在小腿下部和脚踝周围出现界限清晰、呈凿孔状、疼痛且愈合缓慢的溃疡。这些溃疡通常发生在患有长期、严重、血清学阳性疾病的患者身上。目前认为它们是由坏死性动脉炎导致皮肤梗死引起的，因为它们经常与类风湿性血管炎的其他临床特征相关。威尔金森评论说，“很少对腿部溃疡进行活检”。在本文中，我们报告了5例严重类风湿性关节炎患者，他们在没有血管炎其他临床证据的情况下出现了此类腿部溃疡，且溃疡活检未发现血管炎。现将其中1例病例作为这5例患者的代表进行总结，其相关病史、临床检查结果及实验室检查结果汇总于表1。
