CLINICAL IMAGES
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rheumatoid arthritis: results from two large early arthritis cohorts. Arthritis Rheum 2009;60:2262–71. 20. James D, Young A, Kulinskaya E, Knight E, Thompson W, Ollier W, et al. Orthopaedic intervention in early rheumatoid arthritis: occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years. Rheumatology (Oxford) 2004;43:369–76.
21. Humphreys JH, Verstappen SM, Hyrich KL, Chipping JR, Marshall T, Symmons DP. The incidence of rheumatoid arthritis in the UK: comparisons using the 2010 ACR/EULAR classification criteria and the 1987 ACR classification criteria. Results from the Norfolk Arthritis Register. Ann Rheum Dis 2013;72: 1315–20.
DOI 10.1002/art.38612
Clinical Images: A strange livedo
The patient, a 56-year-old woman, presented with a rash of 3 years’ duration on the left thigh. Her main antecedents were obesity (and bariatric surgery) and left knee replacement 3 years earlier (because of osteoarthritis). Initially, red lesions appeared on the affected areas and became progressively darker over the months that followed (A). Physical examination showed a reticulated pattern of hyperpigmented lesions on the left thigh (B). Laboratory tests revealed no abnormal findings (cryoglobulinemia, antinuclear antibodies, antineutrophil cytoplasmic antibodies, and antiphospholipid antibodies were absent, and the patient had negative findings on serologic tests for viral and bacterial infections). Skin biopsy showed an atrophic and hyperkeratotic epidermis and dilated capillaries with atypical endothelial cells (C). We diagnosed her as having erythema ab igne. Following knee surgery 3 years earlier, the patient alleviated pain in the left leg by covering it with a heating pad. Erythema ab igne, a netlike dermatosis, is caused by repeated exposure to moderate levels of heat (infrared radiation). The pathophysiology is unknown, but this level of infrared radiation induces changes in dermal elastic fibers. Erythema ab igne can occur in the setting of chronic pain; lesions can develop on the abdomen or back as a result of using heating pads or hot water bottles. Modern causes of erythema ab igne include the use of laptops. Treatment of erythema ab igne primarily consists of discontinuing use of the heat source. If the exposure continues, permanent dyspigmentation can occur. Other long-term sequelae include the development of squamous cell carcinomas. Mathieu Artifoni, MD Franc¸ois Perrin, MD Elisabeth Cassagnau, MD Marc Antoine Pistorius, MD Se´bastien Barbarot, MD Ce´cile Durant, MD Nantes University Hospital Nantes, France
1681
rheumatoid arthritis: results from two large early arthritis cohorts. Arthritis Rheum 2009;60:2262–71. 20. James D, Young A, Kulinskaya E, Knight E, Thompson W, Ollier W, et al. Orthopaedic intervention in early rheumatoid arthritis: occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years. Rheumatology (Oxford) 2004;43:369–76.
21. Humphreys JH, Verstappen SM, Hyrich KL, Chipping JR, Marshall T, Symmons DP. The incidence of rheumatoid arthritis in the UK: comparisons using the 2010 ACR/EULAR classification criteria and the 1987 ACR classification criteria. Results from the Norfolk Arthritis Register. Ann Rheum Dis 2013;72: 1315–20.
DOI 10.1002/art.38612
Clinical Images: A strange livedo
The patient, a 56-year-old woman, presented with a rash of 3 years’ duration on the left thigh. Her main antecedents were obesity (and bariatric surgery) and left knee replacement 3 years earlier (because of osteoarthritis). Initially, red lesions appeared on the affected areas and became progressively darker over the months that followed (A). Physical examination showed a reticulated pattern of hyperpigmented lesions on the left thigh (B). Laboratory tests revealed no abnormal findings (cryoglobulinemia, antinuclear antibodies, antineutrophil cytoplasmic antibodies, and antiphospholipid antibodies were absent, and the patient had negative findings on serologic tests for viral and bacterial infections). Skin biopsy showed an atrophic and hyperkeratotic epidermis and dilated capillaries with atypical endothelial cells (C). We diagnosed her as having erythema ab igne. Following knee surgery 3 years earlier, the patient alleviated pain in the left leg by covering it with a heating pad. Erythema ab igne, a netlike dermatosis, is caused by repeated exposure to moderate levels of heat (infrared radiation). The pathophysiology is unknown, but this level of infrared radiation induces changes in dermal elastic fibers. Erythema ab igne can occur in the setting of chronic pain; lesions can develop on the abdomen or back as a result of using heating pads or hot water bottles. Modern causes of erythema ab igne include the use of laptops. Treatment of erythema ab igne primarily consists of discontinuing use of the heat source. If the exposure continues, permanent dyspigmentation can occur. Other long-term sequelae include the development of squamous cell carcinomas. Mathieu Artifoni, MD Franc¸ois Perrin, MD Elisabeth Cassagnau, MD Marc Antoine Pistorius, MD Se´bastien Barbarot, MD Ce´cile Durant, MD Nantes University Hospital Nantes, France
