Drug-associated Cutaneous Vasculitis: Study of 239 Patients from a Single Referral Center

Objective.The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides defined drug-associated immune complex vasculitis as a distinct entity included within the category of vasculitis associated with probable etiology. In the present study we assessed the clinical spectrum of patients with drug-associated cutaneous vasculitis (DACV).Methods.Case records were reviewed of patients with DACV treated at a tertiary referral hospital over a 36-year period. A diagnosis of DACV was considered if the drug was taken within a week before the onset of the disease.Results.From a series of 773 unselected cutaneous vasculitis cases, 239 patients (30.9%; 133 men and 106 women; mean age 36 yrs) were diagnosed with DACV. Antibiotics (n = 149; 62.3%), mainly β-lactams and nonsteroidal antiinflammatory drugs (NSAID; n = 24; 10%) were the most common drugs. Besides skin lesions (100%), the most common clinical features were joint (51%) and gastrointestinal (38.1%) manifestations, nephropathy (34.7%), and fever (23.8%). The most remarkable laboratory data were increased erythrocyte sedimentation rate (40.2%), presence of serum cryoglobulins (26%), leukocytosis (24.7%), positive antinuclear antibodies (21.1%), anemia (18.8%), and positive rheumatoid factor (17.5%). Despite drug discontinuation and bed rest, 108 patients (45.2%) required medical treatment, mainly corticosteroids (n = 71) or immunosuppressive drugs (n = 7). After a median followup of 5 months, relapses occurred in 18.4% of patients, and persistent microhematuria or renal insufficiency in 3.3% and 5%, respectively.Conclusion.DACV is generally associated with antibiotics and NSAID. In most cases it has a favorable prognosis, although a small percentage of patients may develop residual renal damage.

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Erythema nodosum

Romanian Journal of Infectious Diseases ◽

10.37897/rjid.2016.1.1 ◽

2016 ◽

Vol 19 (1) ◽

pp. 5-9

Author(s):

Vasile Valeriu Lupu ◽

◽

Ancuţa Ignat ◽

Gabriela Stoleriu ◽

Angelica Cristina Marin ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Erythema Nodosum ◽

Bed Rest ◽

Nonsteroidal Antiinflammatory Drugs ◽

Sudden Onset ◽

Lower Limbs ◽

Antiinflammatory Drugs ◽

Rheumatologic Diseases ◽

Systemic Corticosteroids ◽

Inflammatory Bowel

Erythema nodosum is the most frequent clinicopathologic variant of panniculitis. Triggers are represented by infections, sarcoidosis, rheumatologic diseases, inflammatory bowel disease, medications, autoimmune disorders, pregnancy and malignancy. Erythema nodosum typically manifests by the sudden onset of symmetrical, erythematous, warm nodules, usually located on the lower limbs. Often the lesions are bilaterally distributed. Treatment of erythema nodosum should be directed to the underlying associated condition, if identified. Usually, nodules of erythema nodosum regress spontaneously within a few weeks, and bed rest is often sufficient treatment. Nonsteroidal antiinflammatory drugs and potassium iodide may be helpful drugs to enhance analgesia and resolution. Systemic corticosteroids are rarely indicated in erythema nodosum and before these drugs are administered, an underlying infection should be ruled out.

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Outcomes of Children Treated for Lyme Arthritis: Results of a Large Pediatric Cohort

The Journal of Rheumatology ◽

10.3899/jrheum.090711 ◽

2010 ◽

Vol 37 (5) ◽

pp. 1049-1055 ◽

Cited By ~ 43

Author(s):

HEATHER O. TORY ◽

DAVID ZURAKOWSKI ◽

ROBERT P. SUNDEL

Keyword(s):

Antibiotic Therapy ◽

Treatment Guidelines ◽

Tertiary Care ◽

Laboratory Data ◽

Current Treatment ◽

Nonsteroidal Antiinflammatory Drugs ◽

Chronic Arthritis ◽

Lyme Arthritis ◽

Joint Involvement ◽

Antiinflammatory Drugs

Objective.Children often develop arthritis secondary to Lyme disease; however, optimal treatment of Lyme arthritis in pediatric patients remains ill-defined. We sought to characterize the outcomes of a large cohort of children with Lyme arthritis treated using the approach recommended by the American Academy of Pediatrics and the Infectious Diseases Society of America.Methods.Medical records of patients with Lyme arthritis seen by rheumatologists at a tertiary care children’s hospital from 1997 to 2007 were reviewed. Patients were classified with antibiotic responsive or refractory arthritis based on absence or presence of persisting joint involvement 3 months after antibiotic initiation. Treatment regimens and outcomes in patients with refractory arthritis were analyzed.Results.Of 99 children with Lyme arthritis, 76 had arthritis that responded fully to antibiotics, while 23 developed refractory arthritis. Most patients with refractory arthritis were successfully treated with nonsteroidal antiinflammatory drugs (6 patients), intraarticular steroid injections (4), or disease-modifying antirheumatic drugs (DMARD) (2). Five were lost to followup. Six patients with refractory arthritis were initially treated elsewhere and received additional antibiotic therapy, with no apparent benefit. Three subsequently required DMARD, while 3 had gradual resolution of arthritis without further therapy. Antibiotic responsiveness could not be predicted from our clinical or laboratory data.Conclusion.Lyme arthritis in children has an excellent prognosis. More than 75% of referred cases resolved with antibiotic therapy. Of patients with antibiotic refractory arthritis, none in whom followup data were available developed chronic arthritis, joint deformities, or recurrence of infection, supporting current treatment guidelines.

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Off-label Use of Secukinumab: A Potential Therapeutic Option for SAPHO Syndrome

The Journal of Rheumatology ◽

10.3899/jrheum.211155 ◽

2021 ◽

pp. jrheum.211155

Author(s):

Gang Wang ◽

Ning Zhuo ◽

Jingyang Li

Keyword(s):

Therapeutic Option ◽

Skin Lesions ◽

Nonsteroidal Antiinflammatory Drugs ◽

Substantial Improvement ◽

Sapho Syndrome ◽

Whole Body ◽

Antiinflammatory Drugs ◽

Before And After ◽

Body Magnetic Resonance Imaging ◽

Clinical Conditions

We read the recent article by Wang et al with great interest.1 The authors described a cohort of 4 patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome who showed substantial improvement in skin lesions, clinical conditions, and whole-body magnetic resonance imaging before and after treatment with secukinumab without concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), nonsteroidal antiinflammatory drugs (NSAIDs), or other biologics, and suggested a potential benefit of secukinumab in the treatment of SAPHO syndrome. However, there are some details that need further clarification.

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