Skin inflammation associated with arthritis, synovitis and enthesitis. Part 1: psoriatic arthritis, SAPHO syndrome, Still's disease, Behçet's disease

Abstract

SummaryThe coincidence of skin and joint inflammation poses a challenge for both dermatologists and rheumatologists. Adequate management of such disorders requires that physicians of both specialties have sound knowledge of the other discipline. In case of suspected joint involvement, familiarity with the diagnostic options available to rheumatologists enables dermatologists to selectively refer their patients for a rheumatology consult. The objective of the present review is to familiarize the reader with the stepwise diagnostic workup performed by rheumatologists today, including laboratory tests, musculoskeletal ultrasound, X‐ray studies, and magnetic resonance imaging. Subsequently, we will discuss a number of disorders characterized by the concurrence of skin and joint inflammation, highlighting aspects of epidemiology, etiology and pathogenesis, clinical presentation, diagnosis and treatment. These disorders include psoriatic arthritis as well as autoinflammatory disorders such as SAPHO syndrome, Still's disease and Behçet's disease.

Behçet’s‐like disease during secukinumab treatment: new paradoxical reaction?

“…Recently, preliminary efficacy data of anti-IL-17 drugs have been reported in Behçet's disease, given the implication of IL-17 in the pathogenesis of oral ulcers [13]. Therefore, the appearance of Behçet's-like features during secukinumab treatment could be interpreted as a paradoxical reaction related to the use of this drug [14].…”

SAPHO syndrome associated with a digestive disorder in a ten-year-old girl: Diagnostic difficulties

“…SAPHO syndrome (acronym for synovitis, acne, pustulosis, hyperostosis, osteitis) is an auto-inflammatory disease characterized by neutrophilic damage, which may affect the skin, bones, and joints [1,2]. Having a low incidence (1-4/10.000 individuals), it is usually observed in young adults.…”

“…Having a low incidence (1-4/10.000 individuals), it is usually observed in young adults. Rheumatologic involvement is most often axial and the most frequently reported dermatological manifestations are palmoplantar pustulosis and severe acne [1][2][3][4].…”

Behçet‐ähnliche Erkrankung unter Secukinumab‐Behandlung: neue paradoxe Reaktion?

“…Da IL-17 in die Pathogenese oraler Ulzera involviert ist, wurden kürzlich vorläufige Daten zur Wirksamkeit von Anti-IL-17-Medikamenten bei Morbus Behçet beschrieben [13]. Das Auftreten Behçet-ähnlicher Symptome während der Secukinumab-Behandlung könnte daher als paradoxe Reaktion interpretiert werden [14].…”

“…In vitro-Studien zeigten, dass Th17-Zellen, die wichtigsten IL-17-produzierenden Zellen, möglicherweise eine Schlüsselrolle in der Immunpathogenese des Morbus Behçet spielen. Aus diesem Grund könnte die Blockade von IL-17 das Auftreten Behçet-ähnlicher Symptome, insbesondere von Aphthen, erklären[11,12].Da IL-17 in die Pathogenese oraler Ulzera involviert ist, wurden kürzlich vorläufige Daten zur Wirksamkeit von Anti-IL-17-Medikamenten bei Morbus Behçet beschrieben[13]. Das Auftreten Behçet-ähnlicher Symptome während der Secukinumab-Behandlung könnte daher als paradoxe Reaktion interpretiert werden[14].Wir beschreiben den Fall einer Behçet-ähnlichen Reaktion unter Secukinumab-Behandlung bei einer Patientin, die früher eine psoriatische Alopezie/Alopecia-areata-ähnliche paradoxe Reaktion unter Certolizumab-Pegol-Therapie zeigte.…”