A 66-year-old woman was seen with a 2-year history of a reddish-brown plaque on her right elbow. She had a history of rheumatoid arthritis (RA) for about 8 years and was referred to our hospital for consultation regarding the skin lesion. Physical examination revealed a reddish-brown plaque with edema on her right elbow (Figure 1A). The joint underlying the skin lesion was painful. Abnormal laboratory levels included C-reactive protein (CRP), 4.04 mg/dL; anticyclic citrullinated peptide antibodies, 156.8 U/mL (normal, <4.5 U/mL); matrix metalloproteinase-3, 467.0 ng/mL (normal range, 17.3-59.7 ng/mL); rheumatoid factor, 56 IU/mL (normal, <20 IU/mL). Her DAS28-CRP score (disease activity score of 28 joints using CRP) was 3.22. (To convert C-reactive protein to nanomoles per liter, multiply by 9.524.)
Sakaguchi M, Nagai H, Tsuji G, Morinobu A, Kumagai S, Nishigori C. Effectiveness of Infliximab for Intralymphatic Histiocytosis With Rheumatoid Arthritis. Arch Dermatol. 2011;147(1):131–133. doi:https://doi.org/10.1001/archdermatol.2010.407
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