[Rheumatoid neutrophilic dermatitis]. / Dermatose neutrophilique rhumatoïde.

BACKGROUND: Rhumatoid arthritis (RA) is a chronic inflammatory joint disease. It appears to be caused by a combination of genetic and environmental factors. It may be accompanied by well-known extra-articular damage (e.g. lung, kidney, heart), while cutaneous involvement such as rheumatoid neutrophilic dermatitis (RND) is much less frequent. PATIENTS AND METHODS: A 64-year-old woman was referred by rheumatologists after she developed a cutaneous eruption on the forearms, elbows and scalp in a setting of progressive RA. A skin biopsy showed a dermal neutrophilic infiltrate throughout its entire thickness as well as leukocytoclasia, with fibrinoid material visible in certain areas. No vasculitis was observed. This histological examination led to a diagnosis of RND. The eruption was successfully treated with topical corticosteroids. COMMENTS: RND is a rare sign in RA that presents clinically as plaques, erythematous nodules or urticarial lesions. The lesions tend to disappear naturally or on treatment of RA. Topical corticosteroids or systemic therapy, in particular dapsone, may be suggested to treat cutaneous damage.

Longitudinal analysis of bone mineral density in pre-menopausal female systemic lupus erythematosus patients: deleterious role of glucocorticoid therapy at the lumbar spine.

OBJECTIVE: To evaluate whether bone loss occurs over time in pre-menopausal systemic lupus erythematosus (SLE) patients. METHODS: We performed a longitudinal bone mineral density (BMD) analysis in a group of 35 pre-menopausal female SLE patients. Lumbar spine and hip (total and sub-regions) BMDs were measured twice 21 +/- 11 (mean +/- S.D.) months apart by dual-energy X-ray absorptiometry. RESULTS: In the whole cohort of SLE patients, significant bone loss was observed at the lumbar spine (-1.22%/yr) but not at the total hip. Further analyses indicated that lumbar spine bone loss (-2.12%/yr) occurred exclusively in the subgroup of patients who had taken a mean prednisolone daily dose >7.5 mg between the two BMD measurements. Moreover, bone loss was more important in patients who had previously received a cumulative prednisolone dose 7.5 mg.