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Fibroblastic rheumatism: a report of 4 cases with potential therapeutic implications.

Publication ,  Journal Article
Jurado, SA; Alvin, GKG; Selim, MA; Pipkin, CA; Kress, D; Jamora, MJJ; Billings, SD
Published in: J Am Acad Dermatol
June 2012

BACKGROUND: Fibroblastic rheumatism is a rare dermatoarthropathy characterized by the sudden onset of cutaneous nodules, flexion contractures, and polyarthritis. Histopathology in the correct clinical context confirms the diagnosis. Treatment is based on observational data from single case reports. OBJECTIVE: We describe 4 cases, review histologic findings, and discuss therapeutic responses. METHODS: Cases coded as fibroblastic rheumatism were retrieved from institutional and consultation files. Medical charts and biopsy specimens were reviewed. Elastic stains and immunostains for smooth muscle actin, S100, CD34, desmin, and epithelial membrane antigen were performed on selected cases. RESULTS: Four cases were identified. Patients displayed cutaneous nodules and arthralgias. Flexion contractures/decreased motion were present in two patients; one patient had associated Raynaud phenomenon and erosive joint disease. Biopsy specimens demonstrated a fibroblastic proliferation associated with a collagenous stroma. Growth patterns varied from cellular fascicles to paucicellular randomly arranged spindle cells. Elastic fibers were absent in all cases tested (3/3). Immunohistochemical stains demonstrated immunoreactivity for smooth muscle actin in one of 3 cases in a myofibroblastic pattern. Other stains were negative. One patient had complete resolution of disease with methotrexate. One patient partially responded to interferon-alfa and ribavirin and was subsequently treated with methotrexate with additional improvement. One patient had limited response to all therapies attempted. One patient was lost to follow-up. LIMITATIONS: Small sample size (n = 4) is a limitation. CONCLUSION: Our data expand the clinical, histologic, and therapeutic response data on fibroblastic rheumatism. Correlation with clinical history is critical to avoid misdiagnosis as other fibrosing lesions. Methotrexate and interferon-alfa are potential therapies.

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Published In

J Am Acad Dermatol

DOI

EISSN

1097-6787

Publication Date

June 2012

Volume

66

Issue

6

Start / End Page

959 / 965

Location

United States

Related Subject Headings

  • Rheumatic Diseases
  • Raynaud Disease
  • Methotrexate
  • Male
  • Interferon-alpha
  • Immunologic Factors
  • Humans
  • Fibroblasts
  • Diagnosis, Differential
  • Dermatology & Venereal Diseases
 

Citation

APA
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Jurado, S. A., Alvin, G. K. G., Selim, M. A., Pipkin, C. A., Kress, D., Jamora, M. J. J., & Billings, S. D. (2012). Fibroblastic rheumatism: a report of 4 cases with potential therapeutic implications. J Am Acad Dermatol, 66(6), 959–965. https://doi.org/10.1016/j.jaad.2011.07.013
Jurado, Sara A., GK Glen Alvin, M Angelica Selim, Clare A. Pipkin, Douglas Kress, Maria Jasmin J. Jamora, and Steven D. Billings. “Fibroblastic rheumatism: a report of 4 cases with potential therapeutic implications.J Am Acad Dermatol 66, no. 6 (June 2012): 959–65. https://doi.org/10.1016/j.jaad.2011.07.013.
Jurado SA, Alvin GKG, Selim MA, Pipkin CA, Kress D, Jamora MJJ, et al. Fibroblastic rheumatism: a report of 4 cases with potential therapeutic implications. J Am Acad Dermatol. 2012 Jun;66(6):959–65.
Jurado, Sara A., et al. “Fibroblastic rheumatism: a report of 4 cases with potential therapeutic implications.J Am Acad Dermatol, vol. 66, no. 6, June 2012, pp. 959–65. Pubmed, doi:10.1016/j.jaad.2011.07.013.
Jurado SA, Alvin GKG, Selim MA, Pipkin CA, Kress D, Jamora MJJ, Billings SD. Fibroblastic rheumatism: a report of 4 cases with potential therapeutic implications. J Am Acad Dermatol. 2012 Jun;66(6):959–965.

Published In

J Am Acad Dermatol

DOI

EISSN

1097-6787

Publication Date

June 2012

Volume

66

Issue

6

Start / End Page

959 / 965

Location

United States

Related Subject Headings

  • Rheumatic Diseases
  • Raynaud Disease
  • Methotrexate
  • Male
  • Interferon-alpha
  • Immunologic Factors
  • Humans
  • Fibroblasts
  • Diagnosis, Differential
  • Dermatology & Venereal Diseases