Multiple rheumatoid papules characteristic of the early stage of rheumatoid vasculitis

The rheumatoid papule has recently been described as the skin manifestation of rheumatoid arthritis (RA). The papules represent leukocytoclastic vascu litis and necrobiosis clinicopathologically. We report a 59-year-old Japane se woman with multiple recurrent rheumatoid papules located on the bilatera l extensor forearms in correlation with the level of RA activity and as a c utaneous manifestation of rheumatoid vasculitis. These papules appeared pri or to other cutaneous manifestations. It was suggested that rheumatoid papu les represent the early stage of rheumatoid vasculitis and that they are a reliable early clinical marker of rheumatoid vasculitis.