Skin rash and arthritis a simplified appraisal of less common associations

Abstract

Skin and joint manifestations are part of the clinical spectrum of many disorders. Well-known associations include psoriatic arthritis and arthritis associated with autoimmune connective tissue diseases. This review focuses on less common associations where skin lesions can provide easily accessible and valuable diagnostic clues, and directly lead to the specific diagnosis or limit the list of possibilities. This may also affect health care resources as diagnostic tests are often low-specific, highly expensive and poorly available. This group of diseases can be divided into two subsets, based on the presence/absence of fever, and then further classified according to elementary skin lesions (macular, urticarial, maculo-papular, vesico-bullous, pustular, petechial and nodular). In most instances joint involvement occurs as peripheral migrating polyarthritis. Erythematosus macular or urticarial rashes occur in most febrile disorders such as monogenic autoinflammatory syndromes, Schnitzler's syndrome, Still's disease and rheumatic fever and afebrile diseases as urticarial vasculitis. Pustular rash may be observed in chronic recurrent multifocal osteomyelitis (CRMO) and pyogenic arthritis with pyoderma gangrenosum and acne (PAPA) syndrome (both febrile) as well as in Behcet's disease and Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome (both non-febrile). Papular lesions are typical of secondary syphilis, sarcoidosis, interstitial granulomatous dermatitis, papular petechial of cutaneous small-vessel vasculitis and nodular lesions of polyarteritis nodosa and multicentric reticulohistiocytosis all of which are afebrile. Differential diagnosis includes infections and drug reactions which may mimic several of these conditions. To biopsy the right skin lesion at the right time it is essential to obtain relevant histological information.

Interstitial Granulomatous Dermatitis as the Initial Manifestation of Granulomatosis with Polyangiitis

“…IGD is a rare pathological skin disorder that mainly presents as non-painful and non-pruritic violaceous lesions on the trunk and arms [ 6 ]. Histologically, it is characterized by granulomatous inflammation concurring with palisades of histocytes [ 7 ]. Although the pathophysiology of this disorder is not clearly understood, it is thought to be most likely secondary to immune complex deposition [ 8 ].…”

Hautzeichen bei rheumatologischen Erkrankungen im Kindes- und Jugendalter

“…In der Anfangsphase sind daher weder febrile Verläufe noch begleitende Arthralgien zur klaren Klärung der Genese geeignet. Für gezielte rheumatologische Diagnostik relevant sind insbesondere chronisch undulierende oder rezidivierende Verläufe, mit oder ohne Fieberepisode [1].…”

A Man With Recurrent Fever, Episodic Rash, and Pain

“…The key symptoms in approaching this case were the coexistence of rash and musculoskeletal pain. While the differential diagnosis of rash and arthritis is broad and has been reviewed elsewhere (1), the diagnostic possibilities in the setting of urticarial rash, bone pain, arthralgia, and a monoclonal protein are relatively limited. Urticaria and monoclonal proteins are briefly reviewed below.…”