Williams F M, Cohen P R, Arnett F C
Department of Medicine, The University of Texas-Houston Medical School, 77030, USA.
J Am Acad Dermatol. 1998 Aug;39(2 Pt 2):359-62. doi: 10.1016/s0190-9622(98)70390-1.
Rheumatoid nodulosis is characterized by multiple small subcutaneous granulomatous nodules typically located on the elbows in approximately 20% of patients with rheumatoid arthritis. Accelerated rheumatoid nodulosis, especially involving the hands and feet, has recently been reported in patients receiving methotrexate therapy for rheumatoid arthritis. We describe a woman with seropositive, erosive rheumatoid arthritis who, on two occasions, developed nonperiarticular subcutaneous nodules and new heart murmurs during methotrexate therapy, while her arthritis remained under good control. The nodules resolved after methotrexate was discontinued and recurred after methotrexate was reintroduced. They again resolved after methotrexate was stopped and colchicine was added. Her DNA oligotyping was positive for HLA-DRB1*0401, a genetic risk factor associated with accelerated rheumatoid nodulosis. Cutaneous biopsy specimens revealed palisading granulomas and giant cells consistent with rheumatoid nodulosis.
类风湿结节病的特征是多个小的皮下肉芽肿性结节，通常位于约20%类风湿关节炎患者的肘部。最近有报道称，接受甲氨蝶呤治疗类风湿关节炎的患者出现了加速性类风湿结节病，尤其是累及手和足。我们描述了一名血清学阳性、侵蚀性类风湿关节炎女性患者，在接受甲氨蝶呤治疗期间，两次出现非关节周围皮下结节和新的心杂音，而她的关节炎仍得到良好控制。停用甲氨蝶呤后结节消退，重新使用甲氨蝶呤后复发。在停用甲氨蝶呤并加用秋水仙碱后结节再次消退。她的DNA寡核苷酸分型显示HLA-DRB1*0401阳性，这是一种与加速性类风湿结节病相关的遗传危险因素。皮肤活检标本显示有符合类风湿结节病的栅栏状肉芽肿和巨细胞。
