Rheumatoid Arthritis: Werth VP

Werth VP, Levinson AI. · No affiliation provided · Arch Dermatol. · Pubmed #11453818 No free full text.

This publication has no abstract.

Levin J, Werth VP. · Department of Dermatology, University of Pennsylvania, PA 19104, USA. · Best Pract Res Clin Rheumatol. · Pubmed #16979539 No free full text.

Abstract: Many inflammatory, metabolic and infectious diseases affect the skin and joints. Most of these, such as rheumatoid arthritis and systemic lupus erythaematosus, are considered to be rheumatic conditions with secondary skin involvement. However, several primary cutaneous diseases are associated with arthritis and may even present with joint symptoms prior to cutaneous lesions. Common skin disorders, such as acne and psoriasis, have well-known musculoskeletal manifestations. Other less common conditions, such as dermatomyositis, multicentric reticulohistiocytosis, pyoderma gangrenosum, Sweet's syndrome and various cutaneous vasculitides, also have frequent joint involvement. This review will discuss the clinical presentation, both cutaneous and musculoskeletal, diagnosis and management of these disorders.

Albrecht J, Atzeni F, Baldini C, Bombardieri S, Dalakas MC, Demirkesen C, Yazici H, Mat C, Werth VP, Sarzi-Puttini P. · Department of Dermatology, University of Pennsylvania, Philadelphia, USA. · Clin Exp Rheumatol. · Pubmed #16466625 No free full text.

Abstract: This paper focuses on skin manifestations that can be observed in autoimmune diseases such as rheumatoid arthritis (RA), Sjögren syndrome (SS), dermatomyositis (DM) and Behçet syndrome (BS). In RA the most widely recognized skin lesion is the rheumatoid nodule. Other cutaneous manifestations can be observed either non-specific or related to the disease itself and/or to the commonly used drugs. Cutaneous manifestations are considered one of the most typical extraglandular features of primary SS, generally they are distinguished in vasculitic and non vasculitic lesions. Among non-vasculitc lesions, skin dryness (xerosis) has been shown to be very common in pSS while vasculitis lesions include typically flat and palpable purpura and urticarial vasculits. In DM the skin manifestations are also frequent and include a heliotrope rash (blue-purple discoloration) on the upper eyelids with edema, a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron rash). The most frequent mucocutaneous finding in BS is aphthous stomatitis which can not usually be differentiated from idiopatic reccurrent aphthous stomatitis on clinical grounds. The most typical skin manifestations are nodular lesions, which are commonly seen in BS and may be due to panniculitis [erythema nodosum (EN)-like lesions] or superficial thrombophlebitis.

Galaria NA, Werth VP, Schumacher HR. · Department of Dermatology, Hospital of the University of Pennsylvania, and the Veterans Administration Hospital, Philadelphia, USA. · J Rheumatol. · Pubmed #10955351 No free full text.

Abstract: Recently etanercept, a soluble recombinant tumor necrosis factor receptor:Fc fusion protein, became available to treat patients with rheumatoid arthritis (RA). Among adverse reactions are cutaneous side effects, which occur in about 5% of patients. These have included mostly injection site reactions as well as urticarial reactions. We describe the first case of leukocytoclastic vasculitis associated with the use of etanercept in a patient with severe, deforming RA previously unresponsive to multiple therapies. Discontinuation of the drug led to complete resolution of the vasculitis.

Haimowitz JE, McCauliffe DP, Seykora J, Werth VP. · Department of Dermatology, University of Pennsylvania, Cooper Medical Center, Philadelphia 19104, USA. · J Am Acad Dermatol. · Pubmed #10827414 No free full text.

Abstract: Annular erythema of Sjögren's syndrome (AE-SS) is believed to be the Asian counterpart of subacute cutaneous lupus erythematosus (SCLE) in white persons. We report the second case of a white person with AE-SS, diagnosed by clinical and serologic findings, as well as the absence of histologic criteria for SCLE. The diagnosis of AE-SS was established by symptoms of xerophthalmia and xerostomia, as well as by examination of skin and salivary gland biopsy specimens. Evaluation showed the presence of anti-Ro(SS-A) and anti-La(SS-B) autoantibody, with the presence of anti-Ro(SS-A) antibody against the 60-kd, but not the 52-kd, epitope, a pattern frequently seen in both the Asians with AE-SS and in white patients with SCLE. Both skin and sicca symptoms were alleviated with combination antimalarial therapy, which included hydroxychloroquine and quinacrine. This case demonstrates that AE-SS can occur in white patients and that the autoantibody profile is similar to that described in Asians with this disease.

Shapiro M, Jimenez S, Werth VP. · Department of Medicine, Pennsylvania Hospital, Philadelphia, USA. · J Am Acad Dermatol. · Pubmed #10642693 No free full text.

Abstract: D: -Penicillamine-induced pemphigus occurs infrequently, typically in patients with rheumatoid arthritis. We describe a patient with systemic sclerosis who experienced this complication 3 months after starting D -penicillamine therapy. Nikolsky's sign, histopathologic findings, and direct immunofluorescence all confirmed the diagnosis. Termination of disease progression required intravenous pulse glucocorticoids, azathioprine, and 3 courses of plasmapheresis. The presentation, treatment, and etiology of D -penicillamine-induced pemphigus are reviewed, and the incidence of this complication in scleroderma patients is examined.