Case Reports in Rheumatology

Case Report

Development of Arthritis as the Initial Involvement in Adult-Onset Cutaneous Polyarteritis Nodosa: Two Cases and Literature Review

Table 1

Review of clinical findings in patients with polyarteritis nodosa (PAN) presenting with arthritis as the initial clinical episode.


Author	Age (years)/Sex	Arthritis		Involvement except for arthritis	Duration since arthritis development		Biopsy		Treatment	Outcome
Author	Age (years)/Sex	Location	Property	Involvement except for arthritis	Skin lesions appearance	c-PAN diagnosis^a	Site	Histology^b	Treatment	Outcome

Smukler [6]	66/M	Ankles, knees	Nondestructive	Livedo reticularis and hair loss on the legs	7 years	7 years	Skin	Definite	PSL	NR
Smukler [6]	66/M	Ankles, knees	Nondestructive	Livedo reticularis and hair loss on the legs	7 years	7 years	Synovium	Nonspecific	Intraarticular CS	NR
Steven [7]	39/M	Right wrist, knee, left hip, ankles	Destructive	Erythematous macular rash on the legs	4 years	6 years	Skin	Definite	PSL, SSZ	NR
Flanagan [8]	50/M	Ankles	Destructive	Erythematous papules, ulcers, and patchy violaceous eruption on the legs	4 years	8 years	Skin	Definite	PSL, CPA	PR
	50/M	Ankles	Destructive		4 years	8 years	Synovium	Nonspecific	PSL, CPA	PR
	51/M	Ankles	Nondestructive	Erythematous nodules and livedo reticularis on the legs; ulcers on the right leg; mononeuritis in the left leg	Simultaneous	5 months	Skin	Definite	PSL, AZA	CR
Horai [9]	60/F	Left ankle, left MTP	Destructive	Ulcers, erythema, and livedo reticularis on the left leg; medium-sized arterial stenosis in the left leg (angiography)	10 years	10 years	Skin	Definite	PSL, TAC	PR
Atzmony [10]	66/F	Left ankle, left midfoot	Destructive	Livedo reticularis, small erythematous nodules, and skin-colored nodules on the legs; ulcers on the left leg; axonal neuropathy on the legs	4 years	12 years	Skin	Definite	PSL, MTX	PR
Our case 1	74/F	Right knee	Nondestructive	Bilateral digital ulcers	8 months	9 months	Synovium	Definite	mPSL, PSL, MTX	CR
Our case 2	60/F	Ankles	Nondestructive	Erythematous papules on the forearms and legs	14 months	18 months	Skin	Definite	PSL, AZA	CR

c-PAN, cutaneous polyarteritis nodosa; PSL, prednisolone; CS, corticosteroid; NR, no remission; SSZ, sulfasalazine; CPA, cyclophosphamide; PR, partial remission; AZA, azathioprine; CR, complete remission; MTP, metatarsophalangeal joint; TAC, tacrolimus; MTX, methotrexate; mPSL, intravenous infusion of methylprednisolone. ^aAll patients were categorized as c-PAN. ^bThe pathological evaluation is determined as “definite” when the biopsied tissue showed the presence of necrotizing vasculitis compatible with polyarthritis nodosa.