Methotrexate-induced panniculitis in a patient with rheumatoid arthritis

Maashari, Raghda Al; Hamodat, Mowafak

doi:10.15570/actaapa.2016.23

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…Adverse effects associated with the use of MTX additionally include the development of accelerated nodulosis, also known as MTX-induced accelerated nodulosis (MIAN), which occurs in (1–10)% of patients on MTX. 86 However, most adverse effects can be reversed by supplementation with calcium or sodium folinate. 83 …”

Section: Conventional Synthetic Dmards (Cs Dmards)mentioning

confidence: 99%

Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies

et al. 2018

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Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily affects the lining of the synovial joints and is associated with progressive disability, premature death, and socioeconomic burdens. A better understanding of how the pathological mechanisms drive the deterioration of RA progress in individuals is urgently required in order to develop therapies that will effectively treat patients at each stage of the disease progress. Here we dissect the etiology and pathology at specific stages: (i) triggering, (ii) maturation, (iii) targeting, and (iv) fulminant stage, concomitant with hyperplastic synovium, cartilage damage, bone erosion, and systemic consequences. Modern pharmacologic therapies (including conventional, biological, and novel potential small molecule disease-modifying anti-rheumatic drugs) remain the mainstay of RA treatment and there has been significant progress toward achieving disease remission without joint deformity. Despite this, a significant proportion of RA patients do not effectively respond to the current therapies and thus new drugs are urgently required. This review discusses recent advances of our understanding of RA pathogenesis, disease modifying drugs, and provides perspectives on next generation therapeutics for RA.

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Section: Conventional Synthetic Dmards (Cs Dmards)mentioning

confidence: 99%

Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies

et al. 2018

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“…They can appear on the forearms and elbows and even in internal organs. 6 , 7 In nodosity accelerated by methotrexate, the histological alterations resemble those found in the rheumatoid nodule. In the patient in question, this hypothesis was rejected based on the histopathology.…”

Section: Discussionmentioning

confidence: 92%

Granuloma annulare on the palms in an elderly patient

Mello

Fernandes

Gripp

et al. 2018

An. Bras. Dermatol.

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Granuloma annulare is a relatively common, idiopathic, benign inflammatory dermatosis, with a varied clinical presentation that often makes diagnosis difficult. It mainly affects the extremities, such as the dorsa of the hands and feet, forearms and legs. Palmar and plantar regions are generally spared. It occurs mainly in young female patients. The presentation of the palmar variant in an elderly patient is a rarity.

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“…13 Since MTXinduced accelerated nodulosis and panniculitis are linked to patients expressing HLA-DRB1, it is important to note there is a certain genetic susceptibility present in these patients. 6,7 Therefore, the hypothesised mechanism of MTX's role in the pathogenesis of SURN could be similar.…”

Section: Discussionmentioning

confidence: 99%

“…6 Furthermore, additional evidence suggests a correlation between MTX-induced accelerated nodulosis and subsequent panniculitis in these susceptible individuals. 7 Superficial ulcerating necrobiosis, a rare entity that may accompany RA, can develop to become superficial ulcerating rheumatoid necrobiosis (SURN). 8 Necrobiosis is a generalised descriptor that refers to skin without connective tissue fibres upon histological examination Histologically, these lesions are characterised by bordering palisading histiocytes, multinucleated cells, and epithelioid cells.…”

Section: Introductionmentioning

confidence: 99%

Superficial Ulcerating Rheumatoid Necrobiosis Associated with Methotrexate Use in a Patient with Rheumatoid Arthritis

Cusick

Goyal

Merten

et al. 2020

EMJ

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Methotrexate, a disease-modifying antirheumatic drug, is fundamental to limiting progression in several rheumatic diseases such as rheumatoid arthritis (RA). However, methotrexate is also associated with various significant adverse effects. Of note, there are several dermatologic manifestations attributed to methotrexate therapy. In particular, accelerated nodulosis and panniculitis are linked to methotrexate therapy in the current literature. The authors present the case of a 55-year-old Caucasian female with seropositive erosive RA who developed superficial ulcerating rheumatoid necrobiosis (SURN), secondary to methotrexate therapy. The patient’s treatment consisted of methotrexate discontinuation, topical clobetasol, and initiation of leflunomide as a replacement of methotrexate. Follow-up evaluation confirmed resolution of SURN over time and maintained low disease RA activity with leflunomide.Few cases describe SURN in the setting of RA and there are currently no cases published that suggest methotrexate’s possible role in SURN. Methotrexate-induced SURN is plausible in this case because of the correlation with therapy initiation and remission after therapy discontinuation. SURN has significant histological overlap with other methotrexate-induced dermatologic manifestations, allowing for a possible correlation. Most dermatological side effects of methotrexate are linked to a genetic predisposition of the HLA-DRB1 gene. Additionally, methotrexate’s mechanism of action for rheumatologic disease paradoxically stimulates adenosine-1 receptors and activates neutrophil chemotaxis and phagocytosis. Adenosine-1 receptor stimulation is hypothesised to be the source of rheumatoid-accelerated nodulosis and possibly SURN. Furthermore, the location of manifestation, genetic predisposition, and comorbid features in the patient all possibly have a role in this unique dermatological side effect.

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Methotrexate-induced panniculitis in a patient with rheumatoid arthritis

Cited by 5 publications

References 4 publications

Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies

Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies

Granuloma annulare on the palms in an elderly patient

Superficial Ulcerating Rheumatoid Necrobiosis Associated with Methotrexate Use in a Patient with Rheumatoid Arthritis

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