PMC2828421_01
Schematic time course of C-reactive protein levels and concurrent therapy. Dashed-line: Prednisolone (mg/d); solid-line: CRP (mg/l). CRP: C-reactive protein; RA: rheumatoid arthritis; GC: general condition; LEF: leflunomide; MTX: methotrexate; SLZ: sulfasalazine; CyA: cyclosporine A.
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F1
In early 2007, the patient was referred to our Department with an acute flare of RA (Figure 1). About half a year later, the patient presented again with highly elevated humoral inflammatory parameters (Figure 1) and pain on exertion in both hips, knees and ankles with swelling of the latter two as well as several MCP joints. However, humoral inflammatory activity was still high (Figure 1), and the patient described his general condition as "deteriorating" with fever, night sweats and loss of body weight. Treatment with MTX was stopped and replaced by sulfasalazine (Figure 1). Following treatment with high dose prednisolone, the patient's condition improved significantly and CRP levels decreased rapidly (Figure 1). However, one month later the patient presented in deteriorated condition with high inflammatory parameters (CRP 220 mg/l, Figure 1). The patient responded well to this treatment and temperature as well as inflammatory markers returned back to normal levels rapidly (Figure 1).
Histology (painful node, left lower leg). Standard histological processing was performed on a painful node obtained from the lower limb. Two HE-stained sections at different magnifications (left 20x, right 30x) are depicted. The sections show predominantly lobular panniculitis with mixed inflammatory cell infiltration.
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F2
The histology of the nodule revealed a lobular panniculitis, with a mixed cell infiltrate dominated by neutrophils (Figure 2).