J Rheum Dis.  2022 Jul;29(3):187-189. 10.4078/jrd.2022.29.3.187.

A Case of Superficial Thrombo-occlusive Vascular Disease in a Patient With Rheumatoid Arthritis

• Park Sj
• Joung Ci
• Cheong SH
• Ryu HY
• Lee GH
• Pyo GJ
• Kwon M

• KMID: 2530683
• DOI: http://doi.org/10.4078/jrd.2022.29.3.187

Figure

• 

  Fig. 1 Her skin lesions with papules and ulcers were shown on her left leg unilaterally (A), and the biopsy site was marked (B). The crust formation (asterisks) was found in the epidermis layer, and there were diffuse infiltrates of inflammatory cells (black arrows) in the upper dermis (x100 high power field [HPF]) (C). High magnification showed neutrophils, lymphocytes (black arrowhead) in the upper dermis, and thrombosis (green arrowheads) in capillaries, and red blood cell extravasation (yellow arrowheads) could be seen (x200 HPF) (D).

• 

  Fig. 2 The changes of the skin lesions. The initial appearance of the skin lesion at her second visit for worsening in December 2020 (A) and after a biopsy, she had prescribed rivaroxaban for superficial thrombo-occlusive vascular disease. In 2 weeks, the skin lesion which being treated with rivaroxaban (B), and in 3 months, she had complete resolution of symptoms (C).

Reference

1. Weishaupt C, Strölin A, Kahle B, Kreuter A, Schneider SW, Gerss J, et al. 2016; Anticoagulation with rivaroxaban for livedoid vasculopathy (RILIVA): a multicentre, single-arm, open-label, phase 2a, proof-of-concept trial. Lancet Haematol. 3:e72–9. DOI: 10.1016/S2352-3026(15)00251-3.

2. Beyer-Westendorf J, Schellong SM, Gerlach H, Rabe E, Weitz JI, Jersemann K, et al. 2017; Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, non-inferiority SURPRISE phase 3b trial. Lancet Haematol. 4:e105–13. DOI: 10.1016/S2352-3026(17)30014-5.

3. Lee JJ, Pope JE. 2014; A meta-analysis of the risk of venous thromboembolism in inflammatory rheumatic diseases. Arthritis Res Ther. 16:435. DOI: 10.1186/s13075-014-0435-y. PMID: 25253302. PMCID: PMC4207310.

4. Chung WS, Peng CL, Lin CL, Chang YJ, Chen YF, Chiang JY, et al. 2014; Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Ann Rheum Dis. 73:1774–80. DOI: 10.1136/annrheumdis-2013-203380. PMID: 23926057.

5. Hairston BR, Davis MD, Pittelkow MR, Ahmed I. 2006; Livedoid vasculopathy: further evidence for procoagulant pathogenesis. Arch Dermatol. 142:1413–8. DOI: 10.1001/archderm.142.11.1413. PMID: 17116831.

6. Vallejo-Yagüe E, Weiler S, Micheroli R, Burden AM. 2020; Thromboembolic safety reporting of tofacitinib and baricitinib: an analysis of the WHO VigiBase. Drug Saf. 43:881–91. DOI: 10.1007/s40264-020-00958-9. PMID: 32533433.

7. Mease P, Charles-Schoeman C, Cohen S, Fallon L, Woolcott J, Yun H, et al. 2020; Incidence of venous and arterial thromboembolic events reported in the tofacitinib rheumatoid arthritis, psoriasis and psoriatic arthritis development programmes and from real-world data. Ann Rheum Dis. 79:1400–13. DOI: 10.1136/annrheumdis-2019-216761. PMID: 32759265. PMCID: PMC7569391.

8. Giménez Poderós T, Gallardo Borge S, Vazquez-Ferreiro P. 2020; Risk of venous thromboembolism associated with tofacitinib and baricitinib: a systematic review and indirect meta-analysis. Pharmacotherapy. 40:1248–64. DOI: 10.1002/phar.2472. PMID: 33064892.

9. Kotyla PJ, Engelmann M, Giemza-Stokłosa J, Wnuk B, Islam MA. 2021; Thromboembolic adverse drug reactions in Janus kinase (JAK) inhibitors: does the inhibitor specificity play a role? Int J Mol Sci. 22:2449. DOI: 10.3390/ijms22052449. PMID: 33671049. PMCID: PMC7957632.