Which of the following is not typically associated with Rheumatoid Arthritis (RA): pyoderma gangrenosum, Gottron papules, or pericarditis?

Gottron Papules Are NOT Associated with Rheumatoid Arthritis

Gottron papules are pathognomonic for dermatomyositis and are not a feature of rheumatoid arthritis (RA). 1

Key Distinguishing Features

Gottron Papules - Dermatomyositis Only

• Gottron papules are erythematous, raised papules over the extensor surfaces of joints (particularly the knuckles, elbows, and knees) that are characteristic of dermatomyositis 1
• These lesions appear alongside other dermatomyositis features including heliotrope rash, periorbital edema, photosensitive rash with poikiloderma, and periungual telangiectasias 1
• Dermatomyositis presents with proximal muscle weakness developing over weeks to months, coupled with elevated muscle enzyme levels 1

Pyoderma Gangrenosum - CAN Be Associated with RA

• Pyoderma gangrenosum is frequently associated with rheumatoid arthritis, occurring in approximately 50% of cases alongside inflammatory bowel disease and hematologic disorders 2, 3
• In inflammatory arthritis-associated pyoderma gangrenosum, joint symptoms typically precede the skin lesions by a median of 10 years 3
• The condition presents as rapidly developing, painful skin ulcers with deep excavating ulcerations containing purulent material that is sterile on culture 4

Pericarditis - IS Associated with RA

• Cardiac manifestations including pericarditis can occur in rheumatoid arthritis, though they may be asymptomatic 1
• Asymptomatic arrhythmias such as sinus tachycardia may be detected by electrocardiography, and diastolic dysfunction may be seen on echocardiography in inflammatory myopathies 1

Clinical Implications

When evaluating a patient with suspected RA, the presence of Gottron papules should immediately redirect your diagnostic consideration toward dermatomyositis rather than RA. 1 This distinction is critical because:

• Dermatomyositis requires evaluation for malignancy, interstitial lung disease, and cardiac involvement 1
• Treatment approaches differ significantly, with dermatomyositis requiring high-dose corticosteroids concurrent with steroid-sparing agents like methotrexate, azathioprine, or mycophenolate mofetil 1
• Misdiagnosis can lead to delayed appropriate therapy and worse outcomes 1

Common Pitfall to Avoid

Do not confuse rheumatoid nodules (which ARE associated with RA) with Gottron papules. Rheumatoid nodules are subcutaneous nodules typically found over pressure points, while Gottron papules are erythematous raised lesions specifically over the extensor surfaces of joints and are pathognomonic for dermatomyositis. 1