title: Incidence and classification of cutaneous manifestations in rheumatoid arthritis.
abstract: OBJECTIVE
  There have only been few studies examining rheumatoid arthritis (RA)-related skin manifestations in larger patient populations. Herein, we present current data on the prevalence and spectrum of cutaneous lesions in RA, addressing disease activity scores, anti-CCP antibodies as well as novel pharmacological approaches.
  
  
  METHODS
  Between November 2006 and July 2007, 214 patients with RA treated at the Division of Rheumatology, University Hospital Jena, Germany, were prospectively examined.
  
  
  RESULTS
  27.5 % of patients exhibited RA-related skin manifestations, almost all of which were rheumatoid nodules. These lesions occurred significantly more frequently in patients with longstanding disease, those testing positive for rheumatoid factor and anti-CCP-antibodies, as well as individuals on leflunomide and TNF-alpha antagonists. Comparatively lower prevalence rates were observed for palisading neutrophilic and granulomatous dermatitis and rheumatoid vasculitis.
  
  
  CONCLUSIONS
  Despite increasingly early treatment of RA and use of novel pharmacological agents, there is a high prevalence of rheumatoid nodules, which represent the most common cutaneous manifestation in RA. The higher prevalence of rheumatoid nodules in patients on leflunomide and TNF-alpha antagonists might be an indication that pharmacological treatment has only limited effects on their formation, possibly due to pathogenetic pathways that are only inadequately affected by drug therapies. By contrast, palisading neutrophilic and granulomatous dermatitis and rheumatoid vasculitis appear to respond better to novel pharmacological agents.
authors.affiliation: Department of Dermatology, Venereology, and Allergology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Ziemer
authors.affiliation: Department of Dermatology, University Hospital Jena, Jena, Germany.
authors.forename: Anne-Katrin
authors.initials: AK
authors.lastname: Müller
authors.affiliation: Division of Rheumatology & Osteology, Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Hein
authors.affiliation: Division of Rheumatology & Osteology, Department of Internal Medicine III, University Hospital Jena, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Oelzner
authors.affiliation: Department of Dermatology, University Hospital Jena, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Elsner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D015984:Causality; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012218:Rheumatoid Nodule / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D012307:Risk Factors; D012871:Skin Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology
keywords: Rheumatoid arthritis; classification; cutaneous manifestations; histopathology; incidence