A 59-Year-Old Woman With Painful Rash on Her Elbows

Victoria M.F. Mank, MD; Jefferson R. Roberts, MD


August 03, 2023

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A 59-year-old white woman presented with a pruritic and painful rash on her elbows, overlaying her rheumatoid nodules. Her past medical history was significant for aggressive seropositive rheumatoid arthritis (RA), poorly controlled type 2 diabetes mellitus, hypothyroidism, and fibromyalgia. Her prescribed treatment at that time was etanercept, leflunomide, and prednisone. However, she frequently self-discontinued medications and did not attend scheduled appointments. Multiple other disease-modifying antirheumatic drugs (DMARDs) were attempted prior to the current combination. These medications included methotrexate, hydroxychloroquine, sulfasalazine, adalimumab, and infliximab.

The rash overlaid her rheumatoid nodules on her elbows and forearms and had worsened, increasing in size and severity, involving her lower extremities and including the bases of her feet and shins since she self-discontinued etanercept. She smoked one pack of cigarettes per day for several years and had polysubstance drug abuse.


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