Rheumatoid Arthritis with Arteritis

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Abstract
A patient is presented who illustrates the syndrome of chronic rheumatoid arthritis, leg ulcers, positive LE cell tests, and a very high titer of rheumatoid factor. The skin ulcerations were due to an underlying arteritis, which ultimately resulted in gangrene of the right lower extremity requiring amputation. For the past year, she was treated with Dpenicillamine, 2 g/day. Associated with this, the titer of rheumatoid factor gradually fell, as measured by immune precipitation, the latex fixation test, and in the analytical ultracentrifuge. Changes were also found in the intermediate gamma globulin complexes, suggesting that the action of penicillamine was not simply intravascular de polymerization of the rheumatoid macroglobulin. Coincident with the drug administration and serum protein changes, a partial clinical remission ensued. The ulcers healed and have not recurred in one year of followup thus far. Further study of this and related sulfhydryl compounds is warranted in cases of this type.