Subacute cutaneous lupus
This gentleman with a history of seropositive (RF and CCP Positive) rheumatoid arthritis presents with these skin lesion. He had deforming arthropathy of the small joints of his hands consistent with rheumatoid arthritis. Several large necrotic ulcerations were noted in the lower limbs. Vasculitic lesions were also noted.
The musculo-pathology conference yielded a very interesting case as presented by the Paediatric team. A small for gestation baby was delivered and of immediate note was the joint contractures and the evidence of shallow breathing, that could not support life. The baby was put on ventilator support. An attempt at muscle biopsies revealed fibrous strands in place of the muscle at both the upper and lower limb regions. Prognosis was extremely poor and withdrawal of therapy was finally agreed upon with the family.
Methotrexate is the most frequently used first-line antirheumatic drug. We report the findings of a phase 3 study of monotherapy with tofacitinib, an oral Janus kinase inhibitor, as compared with methotrexate monotherapy in patients with rheumatoid arthritis who had not previously received methotrexate or therapeutic doses of methotrexate.
Ann Rheum Dis doi:10.1136/annrheumdis-2014-205228 Head-to-head, randomised, crossover study of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis: drug-exposure limitations of oral methotrexate at doses ≥15 mg may be overcome with subcutaneous administration Michael H Schiff, Jonathan
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The deformities were correctable in a patient with a positive serology for lupus and joint pain.
These real-life data indicate that, after discontinuation of an initial TNFi, switching to rituximab is associated with significantly improved clinical effectiveness compared with switching to a second TNFi. This difference was particularly evident in seropositive patients and in those switched because of inefficacy.
The article below suggests the possible causative mechanism of RA. A step closer to a preventive strategy? Arthritis Res Ther. 2013;15(5):R111. Bacterial lipopolysaccharides form procollagen-endotoxin complexes that trigger cartilage inflammation and degeneration: implications for the development