By Gary M. White, MD
Fibroblastic rheumatism (FR) is a rare condition characterized by symmetrical polyarthritis and multiple cutaneous nodules.
The nodules are smooth, firm and skin-colored to erythematous and characteristically occur over the joints of the fingers. They have been reported to occur on the elbows, knees, ears and neck. Almost all patients develop acute, symmetric polyarthralgias affecting most joints of the upper and lower extremities (most common of the hands and feet), joint stiffness, and varying degrees of loss of range of motion. Early radiographs of the joints do not show destruction, but later, demineralization and marked erosive changes in the epiphyseal areas may be seen.
Skin biopsy, ANA, ENA antibodies, RF, evaluation for signs and symptoms of collagen vascular disease (e.g. telangiectasias, calcinosis cutis, nail fold capillary abnormalities) should be done. Radiographs may be obtained. One patient had elevated lead levels [Clin Exp Dermatol. 2015 Apr;40(3):309-12].
The cutaneous nodules and the arthritis usually resolve spontaneously from 6 months to 2 years from onset, although most patients are left with permanent joint abnormalities. During the active phase, aspirin, NSAID's, and oral corticosteroids may be tried. Colchicine and penicillamine do not seem to work. Interferon alpha has been tried.
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