Mashek H A, Pham C T, Helm T N, Klaus M
Department of Dermatology, State University of New York at Buffalo, USA.
Arch Dermatol. 1997 Jun;133(6):757-60.
Rheumatoid neutrophilic dermatitis (RND) is a recently recognized, rare cutaneous manifestation of rheumatoid arthritis. It occurs in patients with severe rheumatoid arthritis and is typically asymptomatic. Rheumatoid neutrophilic dermatitis was originally described by Ackerman in 1978. Since that time, 8 patients with this disease have been described in the literature.
We report 2 cases of RND. Findings of skin biopsy specimens from both patients revealed characteristic signs of dermal leukocytosis and leukocytoclasia without vasculitis. The pathogenesis of the neutrophilic infiltrate is unclear. Processes that may play a role in the pathogenesis of RND include immune complex activations, cell adhesion and migration, and cytokine release.
Rheumatoid neutrophilic dermatitis falls into the spectrum of neutrophilic vascular reactions described by Jorizzo and Daniels. Although early reports suggest that prominent leukocytoclasia is not a feature of RND, our findings confirm the observations of Lowe et al that leukocytoclasia can be seen in RND and may be striking. It is important for dermatologists to be aware of this rare manifestation of rheumatoid arthritis.
类风湿性嗜中性皮病（RND）是类风湿性关节炎一种最近才被认识到的罕见皮肤表现。它发生于重症类风湿性关节炎患者，通常无症状。类风湿性嗜中性皮病最初由阿克曼于1978年描述。自那时起，文献中已报道了8例患有这种疾病的患者。
我们报告2例RND。两位患者的皮肤活检标本结果显示有真皮白细胞增多和白细胞破碎的特征性表现，无血管炎。嗜中性粒细胞浸润的发病机制尚不清楚。可能在RND发病机制中起作用的过程包括免疫复合物激活、细胞黏附和迁移以及细胞因子释放。
类风湿性嗜中性皮病属于乔里佐和丹尼尔斯所描述的嗜中性血管反应范畴。尽管早期报告提示显著的白细胞破碎不是RND的特征，但我们的发现证实了洛维等人的观察结果，即白细胞破碎在RND中可见且可能很显著。皮肤科医生认识到类风湿性关节炎的这种罕见表现很重要。
