[Cutaneous vasculitis with necrotic ulcers in rheumatoid arthritis: treatment with anti-TNFalpha].
BACKGROUND
Anti-TNFalpha has occasionally been used in the treatment of recalcitrant forms of systemic vasculitis such as Behçet's disease, Wegener's granulomatosis and Churg-Strauss syndrome. We report on the outcome of treatment in rheumatoid arthritis patients with cutaneous vasculitis lesions on anti-TNFalpha.


METHODS
Two patients with rheumatoid arthritis present for several years had necrotic ulcers of the lower limbs due to cutaneous vasculitis. After the failure of various immunosuppressive drugs (cyclophosphamide, azathioprine, methotrexate), the two patients were treated with anti-TNFalpha: infliximab in the first case and adalimumab in the second. Cutaneous ulcers healed within two to four months of the start of anti-TNFalpha treatment. Despite ongoing anti-TNFalpha treatment, these cutaneous ulcers relapsed four to six months after complete healing.


CONCLUSIONS
Initially spectacular healing of cutaneous vasculitis ulcers under anti-TNF alpha treatment followed by relapse after several months of treatment is suggestive of an escape mechanism.
Thirion
L
L
Clinique Dermatologique, CHU de Rouen.
Picard
D
D
Mejjad
O
O
Courville
P
P
Le Loet
X
X
Joly
P
P
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000150:complications*; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab; D008875:Middle Aged; D009336:Necrosis; D012008:Recurrence; D017445:Skin Diseases, Vascular / Q000150:complications / Q000188:drug therapy*; D012883:Skin Ulcer / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D014657:Vasculitis / Q000150:complications / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D000069285:Infliximab; D000068879:Adalimumab