Unusual Skin Lesions of Rheumatoid Arthritis

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Abstract
Two patients are reported with the usual manifestations of rheumatoid arthritis but they also had widespread atypical cutaneous papules, nodules, and ulcerated lesions of the legs. The histopathologic changes in the skin in both patients showed multiple areas of necrobiosis with peripheral palisading of fibrocytes at all levels in the corium, thickening and obliteration of small blood vessels, fibrinoid degeneration, and a granulomatous vasculitis. The ulcers developed in preexisting plaques or nodules. The histopathologic features of a granulomatous vasculitis, the rising levels of macroglobulins and latex rheumatoid arthritis factor are compatible with the cutaneous lesions being due to an immunologic reaction involving the cutaneous blood vessels and extravascular connective tissue.

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