Recurrent and refractory lower limbs lymphedema in psoriatic arthritis: a case description and literature review


Submitted: 7 September 2021
Accepted: 6 October 2021
Published: 21 December 2021
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Authors

Lymphedema is an uncommon extra-articular complication of rheumatoid arthritis (RA), but it can also be associated with psoriatic arthritis (PsA), although rarely. While lymphedema associated with RA is well characterized in literature, only few cases have been described among patients with PsA. Upper limbs are the most common sites involved, with asymmetric pattern, even if some patients may present lower limb oedema, or progressive bilateral oedema.

Chronic established lymphoedema deriving from lymphatic vessel dysfunction should be clearly distinct from inflammatory distal pitting edema (IDPE), resulting from tenosynovitis and frequently encountered in PsA. In contrast to lymphedema, the latter condition generally presents an excellent response to steroid therapy, therefore it is essential to recognize the exact etiology of lymphoedema to approach the correct treatment. Here we report a case of lower limbs lymphedema in PsA and review the available literature upon the topic.


Joos E, Bourgeois P, Famaey JP. Lymphatic disorders in rheumatoid arthritis. Semin Arthritis Rheum. 1993;22:392-8. DOI: https://doi.org/10.1016/S0049-0172(05)80031-9

Bohm M, Riemann B, Luger TA, Bonsmann G. Bilateral upper limb lymphoedema associated with psoriatic arthritis: a case report and review of the literature. Br J Dermatol. 2000;143:1297-301. DOI: https://doi.org/10.1046/j.1365-2133.2000.03905.x

Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665-73. DOI: https://doi.org/10.1002/art.21972

Tessari M, Tisato V, Rimondi E, et al. Effects of intermittent pneumatic compression treatment on clinical outcomes and biochemical markers in patients at low mobility with lower limb edema. J Vasc Surg Venous Lymphat Disord. 2018;6:500-10. DOI: https://doi.org/10.1016/j.jvsv.2018.01.019

Maldonado TS, Rokosh RS, Padberg F, et al. Assessment of quality of life changes in patients with lower extremity lymphedema using an advanced pneumatic compression device at home. J Vasc Surg Venous Lymphat Disord. 2021;9:745-52. DOI: https://doi.org/10.1016/j.jvsv.2020.10.013

The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. Lymphology. 2020;53:3-19. DOI: https://doi.org/10.2458/lymph.4649

O'Donnell TF, Jr., Allison GM, Iafrati MD. A systematic review of guidelines for lymphedema and the need for contemporary intersocietal guidelines for the management of lymphedema. J Vasc Surg Venous Lymphat Disord. 2020;8:676-84. DOI: https://doi.org/10.1016/j.jvsv.2020.03.006

Borman P, Koyuncu EG, Yaman A, et al. The comparative efficacy of conventional short-stretch multilayer bandages and velcro adjustable compression wraps in active treatment phase of patients with lower limb lymphedema. Lymphat Res Biol. 2021;19:286-94. DOI: https://doi.org/10.1089/lrb.2020.0088

Szuba A, Rockson SG. Lymphedema: classification, diagnosis and therapy. Vasc Med. 1998;3:145-56. DOI: https://doi.org/10.1191/135886398674160447

Badger C, Preston N, Seers K, Mortimer P. Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. 2004:CD003141. DOI: https://doi.org/10.1002/14651858.CD003141.pub2

Dacre JE, Scott DL, Huskisson EC. Lymphoedema of the limbs as an extra-articular feature of rheumatoid arthritis. Ann Rheum Dis. 1990;49:722-4. DOI: https://doi.org/10.1136/ard.49.9.722

Dippy JE. Lymphoedema complicating rheumatoid arthritis. Ann Rheum Dis. 1991;50:658. DOI: https://doi.org/10.1136/ard.50.9.658-b

Kalliomaki JL, Vastamaki M. Chronic diffuse oedema of the rheumatoid hand: a sign of local lymphatic involvement. Ann Rheum Dis. 1968;27:167-9. DOI: https://doi.org/10.1136/ard.27.2.167

Lacroix HR, Gruwez JA, Casteels-Van Daele MC, Dequeker J. Lymphedema of the leg associated with rheumatoid arthritis. Lymphology. 1991;24:68-70.

Minari C, Cecconami L, Fioravanti A, et al. Lymphoedema of the limbs in rheumatoid arthritis. Clin Rheumatol. 1994;13:464-9. DOI: https://doi.org/10.1007/BF02242944

Salvarani C, Macchioni PL, Veneziani M, et al. Upper limb lymphedema in psoriatic arthritis. J Rheumatol. 1990;17:273-4.

Mulherin DM, FitzGerald O, Bresnihan B. Lymphedema of the upper limb in patients with psoriatic arthritis. Semin Arthritis Rheum. 1993;22:350-6. DOI: https://doi.org/10.1016/S0049-0172(05)80013-7

Salvarani C, Cantini F, Olivieri I, et al. Distal extremity swelling with pitting edema in psoriatic arthritis: evidence of 2 pathological mechanisms. J Rheumatol. 1999;26:1831-4.

Kiely PD, Joseph AE, Mortimer PS, Bourke BE. Upper limb lymphedema associated with polyarthritis of rheumatoid type. J Rheumatol. 1994;21:1043-5.

Yamamoto T, Nishioka K. Psoriasis arthropathy and lymphedema. J Dermatol. 2002;29:812-4. DOI: https://doi.org/10.1111/j.1346-8138.2002.tb00229.x

Doffoel-Hantz V, Sparsa A, Verbeke S, et al. Lymphoedema: a rare complication of inflammatory rheumatism. Successful treatment with etanercept. Eur J Dermatol. 2007;17:337-8.

Lekpa FK, Economu-Dubosc A, Fevre C, et al. Efficacy of etanercept in lymphedema associated with psoriatic arthritis. J Rheumatol. 2009;36:207-8. DOI: https://doi.org/10.3899/jrheum.080453

Tong D, Eather S, Manolios N. Psoriatic arthritis and chronic lymphoedema: treatment efficacy by adalimumab. Clin Rheumatol. 2009;28:1349-50. DOI: https://doi.org/10.1007/s10067-009-1259-z

Quarta L, Corrado A, d'Onofrio F, et al. Two cases of distal extremity swelling with pitting oedema in psoriatic arthritis: the different pathological mechanisms. Rheumatol Int. 2010;30:1367-70. DOI: https://doi.org/10.1007/s00296-009-1060-y

Martinez-Crespo G R-SF. [Linfedema bilateral en miembros superiores asociado a artritis psoriasica.][Article in Spanish]. Rehabilitacion. 2012;46:250-3. DOI: https://doi.org/10.1016/j.rh.2011.09.004

Condit R. FG. Lower extremity swelling in a patient with psoriatic arthritis. Rheumatology Reports. 2013;5:1-3. DOI: https://doi.org/10.4081/rr.2013.e1

Fourgeaud C VS. [Lymphoedème des membres inférieurs:une manifestation rare des spondyloarthrites.][Article in French]. Rev Med Interne. 2019;40:837-40. DOI: https://doi.org/10.1016/j.revmed.2019.06.007

Kiely PD, Bland JM, Joseph AE, et al. Upper limb lymphatic function in inflammatory arthritis. J Rheumatol. 1995;22:214-7.

Stanton AW, Levick JR, Mortimer PS. Current puzzles presented by postmastectomy oedema (breast cancer related lymphoedema). Vasc Med. 1996;1:213-25. DOI: https://doi.org/10.1177/1358863X9600100306

Svensson WE, Mortimer PS, Tohno E, Cosgrove DO. Colour Doppler demonstrates venous flow abnormalities in breast cancer patients with chronic arm swelling. Eur J Cancer. 1994;30A:657-60. DOI: https://doi.org/10.1016/0959-8049(94)90539-8

Svensson WE, Mortimer PS, Tohno E, Cosgrove DO. Increased arterial inflow demonstrated by Doppler ultrasound in arm swelling following breast cancer treatment. Eur J Cancer. 1994;30A:661-4. DOI: https://doi.org/10.1016/0959-8049(94)90540-1

McCarty DJ, O'Duffy JD, Pearson L, Hunter JB. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA. 1985;254:2763-7. DOI: https://doi.org/10.1001/jama.254.19.2763

Cantini F, Salvarani C, Olivieri I, et al. Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study. Clin Exp Rheumatol. 2001;19:291-6.

Bhakta BB, Pease CT. Late-onset rheumatoid arthritis: is pitting oedema of the hands at onset a good prognostic indicator? Br J Rheumatol. 1997;36:214-9. DOI: https://doi.org/10.1093/rheumatology/36.2.214

Cantini F, Niccoli L, Olivieri I, et al. Remitting distal lower extremity swelling with pitting oedema in acute sarcoidosis. Ann Rheum Dis. 1997;56:565-6. DOI: https://doi.org/10.1136/ard.56.9.565

Olivieri I, Padula A, Favaro L, et al. Dactylitis with pitting oedema of the hand in longstanding ankylosing spondylitis. Clin Rheumatol. 1995;14:701-4. DOI: https://doi.org/10.1007/BF02207940

Olivieri I, Padula A, Pierro A, et al. Late onset undifferentiated seronegative spondyloarthropathy. J Rheumatol. 1995;22:899-903.

Salvarani C, Gabriel S, Hunder GG. Distal extremity swelling with pitting edema in polymyalgia rheumatica. Report on nineteen cases. Arthritis Rheum. 1996;39:73-80. DOI: https://doi.org/10.1002/art.1780390110

Cantini F, Olivieri I, Salvarani C. More on remitting seronegative symmetrical synovitis with pitting edema as paraneoplastic syndrome. J Rheumatol. 1998;25:188-9.

Tada Y, Sato H, Yoshizawa S, et al. Remitting seronegative symmetrical synovitis with pitting edema associated with gastric carcinoma. J Rheumatol. 1997;24:974-5.

Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology. 1988;167:729-35. DOI: https://doi.org/10.1148/radiology.167.3.3363131

Agarwal V, Dabra AK, Kaur R, et al. Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome: ultrasonography as a diagnostic tool. Clin Rheumatol. 2005;24:476-9. DOI: https://doi.org/10.1007/s10067-004-1061-x

Cantini F, Niccoli L, Nannini C, et al. Psoriatic arthritis: a systematic review. Int J Rheum Dis. 2010;13:300-17. DOI: https://doi.org/10.1111/j.1756-185X.2010.01540.x

Maranini, B., Ciancio, G., Tessari, M., & Govoni, M. (2021). Recurrent and refractory lower limbs lymphedema in psoriatic arthritis: a case description and literature review. Veins and Lymphatics, 10(1). https://doi.org/10.4081/vl.2021.10079

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