[en] OBJECTIVE: To analyse the frequency, type, and immunohistological features of
clinical cutaneous vasculitis developing in patients with rheumatoid arthritis
(RA) treated or not with methotrexate as well as their demographic, clinical and
biological characteristics. METHODS: Ninety-one patients with RA receiving 9.5
mg/wk of methotrexate (MTX) were compared for an average observation time of 18
months to 130 matched patients with RA treated with various drugs excluding MTX.
RESULTS: Whether receiving MTX or not, 5.4% of patients with RA developed a
clinical cutaneous vasculitis. There were significant differences between both
groups for 2 variables only: a higher percentage of polyneuropathies and a higher
level of immune complex-plasma levels in non-MTX patients. The immunohistological
analysis did not differentiate both groups. CONCLUSION: The percentage of
cutaneous vasculitis that developed under MTX therapy was not different from that
occurring as a natural complication of longstanding severe RA.
Bacon PA: Extra-articular rheumatoid arthritis. In: McCarty DJ, ed. Arthritis and Allied Conditions, 11th ed. Philadelphia: Lea and Febiger, 1989:1967-98.
Mongan SE, Cass RM, Jacob RF, Vaughan JH: A study of the relation of seronegative and seropositive rheumatoid arthritis to each other and to necrotizing vasculitis. Am J Med 1969;47:23-5.
Gordon DA, Stein JL, Broder I: The extra-articular features of rheumatoid arthritis. A systematic analysis of 127 cases. Am J Med 1973;54:445-52.
Wattiaux MJ, Kahn MF, Thévenet JP, Sauvezie B, Imbert JC: L'atteinte vasculaire dans la polyarthrite rhumatoïde. Ann Méd Interne 1987;138:566-87.
Weinblatt ME, Weissman BL, Holdsworth DE, et al: Longterm prospective study of methotrexate in the treatment of rheumatoid arthritis. 84-month update. Arthritis Rheum 1992;35:129-37.
Kremer JM, Phelps CT: Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis. Update after a mean of 90 months. Arthritis Rheum 1992;35:138-45.
Marks CR, Willkens RF, Wilske KR: Small-vessel vasculitis and methotrexate (letter). Ann Intern Med 1984;100:916.
Segal R, Caspi D, Tishler M, Fishel B, Yaron M: Accelerated nodulosis and vasculitis during methotrexate therapy for rheumatoid arthritis. Arthritis Rheum 1988;31:1182-5.
Jeurissen MEC, Boerbooms AMTh, van de Putte LBA: Eruption of nodulosis and vasculitis during methotrexate therapy for rheumatoid arthritis (letter). Clin Rheumatol 1989;8:417-9.
Didry C, Combe B, Sany J: Absence of efficacy of methotrexate on systemic manifestations of rheumatoid arthritis (abstr). Clinical Rheumatol 1990;9:138.
Lassoued S, Billey T, Pages M, et al: Nodular efflorescence and cutaneous vasculitis in rheumatoid arthritis treated with methotrexate (letter). Presse Med 1992.-21:31.
Kerstens PJSM, Boerbooms AMT, Jeurissen MEC, Fast JH, Assmann KJM, van de Putte LBA: Accelerated nodulosis during low dose methotrexate therapy for rheumatoid arthritis. An analysis of ten cases. J Rheumatol 1992;19:867-71.
Sany J, Anaya JA, Lussiez V, Couret M, Combe B, Daures JP: Treatment of rheumatoid arthritis with methotrexate: A prospective open longterm study of 191 cases. J Rheumatol 1991;18:1323-7.
Alarcon GS, Koopman WJ. Nonperipheral accelerated nodulosis in a methotrexate-treated rheumatoid arthntis patient. Arthritis Rheum 1993;36:132-3.
Rodriguez-Moreno J, del Blanco Barnussell J, Castano Moreno C, Nolla Sole JM, Roig Escofet D: Systemic rheumatoid vasculitis after discontinuation of methotrexate therapy (letter). J Rheumatol 1992;19:178.
Fondevilla Carlos G, Milone Gustavo A, Santiago P: Cutaneous vasculitis after intermediate dose of methotrexate (IDMTX). Br J Haematol 1989;72:591-2.
Lanzkowsky P, Jayabose S, Shende A, Levy R: Vasculitis as a complication of high-dose methotrexate in the treatment of acute leukemia (letter). Am J Dis Child 1976;130:675.
Navarro M, Pedragosa R, Lafuerza A, Rubio D, Huguet P: Leukocytoclastic vasculitis after high-dose methotrexate (letter). Ann Intern Med 1986;105:471-2.
Williams HC, Pembroke AC: Methotrexate in the treatment of vasculitic cutaneous ulceration in rheumatoid arthritis. J R Soc Med 1989;82:763.
Upchurch KS, Heller K, Bress NM: Low dose methotrexate therapy for cutaneous vasculitis and rheumatoid arthritis. J Am Acad Dermatol 1987;17:355-9.
Mitchell MS, Gifford RH, Bertino JR, Kenney JD, Malawista SE: The treatment of disseminated vasculitis with methotrexate. Inflammation 1976;1:285-95.
Tannenbaum H: Combined therapy with methotrexate and prednisone in polyarteritis nodosa. Can Med Assoc 1980;123:893-4
Jorizzo JL, White WL, Wise CM, Zanolli MD, Sheretz EF: Low-dose weekly methotrexate for unusual neutrophilic vascular reactions: cutaneous polyarteritis nodosa and Behçet's disease. J Am Acad Dermatol 1991;24:973-8.
Zubler RH, Nydegger U, Perrin LH, et al: Circulating and intra articular immune complexes in patients with rheumatoid arthntis. Correlation of 1251-Clq binding activity with clinical and biological features of the disease. J Clin Invest 1976;57:1308-19.
Vollertsen RS, Conn DL: Vasculitis associated with rheumatoid arthritis. In: Conn DL, ed. Vasculitic syndromes. Rheum Dis Clin N Am 1990;16:445-61.
Panush RS, Katz P, Longley S, Carter R, Love J, Stanley H: Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clin Rheumatol 1983;2.321-30.
Chang DJ, Paget SA: Neurological complications of rheumatoid arthritis. In: Elkon K, ed Neurologic aspect of rheumatic diseases. Rheum Dis Clin N Am 1993;19:955-73.
Rapoport RJ, Kozin F, Mackel SE, Jordon RD: Cutaneous vascular immunofluorescence in rheumatoid arthritis. Correlation with circulating immune complexes and vasculitis. Am J Med 1980;68:325-31.
Geirsson AJ, Sturfelt G, Truedsson L: Clinical and serological features of severe vasculitis in rheumatoid arthritis: prognostic implication. Ann Rheum Dis 1987;46:727-33
Winkelman RK: The spectrum of cutaneous vasculitis. Clin Rheum Dis 1980;6:413-52
