Skin manifestations in spondyloarthritis

Abstract

Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) – the main skin disease in SpA – has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn’s disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.

Cutaneous and rheumatological manifestations of reactive arthritis: A case report

“…They may include Keratoderma blenorrhagicum, circinate balanitis, ulcerative vulvitis, oral lesions, and nail changes 11,12 . Keratoderma blenorrhagicum typically appears as erythematous macules and papules in the plantar and palmar area, rising into vesicular, often hyperkeratotic plaques and sterile pustules 3 . Only 10% of ReA patients with positive HLA‐B27 develop these lesions 11 .…”

“…Clinical manifestations include mucocutaneous manifestations such as keratoderma blenorrhagicum, circinate balanitis, ulcerative vulvitis, nail changes (dystrophy and thickness), oral lesions, and conjunctivitis. 2,3 The main rheumatological manifestations are asymmetric oligoarticular arthritis of the lower limbs, enthesitis, dactylitis, and inflammatory back pain.The diagnosis of ReA is challenging since no diagnosis criteria are available. We report a case of ReA occurring…”

Wrist arthritis and drug-related malignant melanoma in an ankylosing spondylitis patient: An unusual and rare case report

“…Patients with AS can present impairments accompanied by pain and a decrease in both function and QoL, such as axial involvement, tyoical skin manifestations, altered gait kinematics, higher risk of uveitis, and dactylitis, pulmonary function impairments, and decrease in exercise capacity. [1][2][3][4][5] It has been shown that peripheral arthritis observes in about a third of cases, with asymmetrical involvement of one large joint like the hip, knee, or shoulder. [2] Recent studies have demonstrated that symptomatic enthesopathy of the shoulder is common in patients with AS, and coxitis is the only predictive factor for shoulder enthesitis.…”

“…[1,2] It typically affects the axial joints, most notably the sacroiliac joints; however, other sites of involvement, including peripheral joints and extra-articular manifestations, are also observed. [3][4][5] Pharmacological management of AS includes disease-modifying anti-rheumatic drugs (DMARDs) such as anti-tumor necrosis factor (TNF) agents to control the disease progression. However, patients with AS may still present impairments accompanied by pain and decreased function and quality of life (QoL).…”

“…However, patients with AS may still present impairments accompanied by pain and decreased function and quality of life (QoL). [1][2][3][4] In some cases, the systematic effect of AS disease and Ankylosing spondylitis (AS), which is a chronic inflammatory disease, is the most frequent and severe subtype of seronegative spondyloarthropathies. Although it typically affects the axial skeleton, the spine, peripheral joints, and entheses are frequently involved as well as extra-articular manifestations.…”