ACCELERATED CUTANEOUS NODULOSIS DURING METHOTREXATE THERAPY IN A PATIENT WITH RHEUMATOID-ARTHRITIS

Rheumatoid nodulosis is characterized by multiple small subcutaneous g ranulomatous nodules typically located on the elbows in approximately 20% of patients with rheumatoid arthritis. Accelerated rheumatoid nodu losis, especially involving the hands and feet, has recently been repo rted in patients receiving methotrexate therapy for rheumatoid arthrit is. We describe a woman with seropositive, erosive rheumatoid arthriti s who, on two occasions, developed nonperiarticular subcutaneous nodul es and new heart murmurs during methotrexate therapy, while her arthri tis remained under good control, The nodules resolved after methotrexa te was discontinued and recurred after methotrexate was reintroduced. They again resolved after methotrexate was stopped and colchicine was added. Her DNA oligotyping was positive for HLA-DRB10401, a genetic r isk factor associated with accelerated rheumatoid nodulosis. Cutaneous biopsy specimens revealed palisading granulomas and giant cells consi stent with rheumatoid nodulosis.