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Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides

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Abstract

Extra-articular manifestations of rheumatoid arthritis, juvenile idiopathic arthritis, and various spondyloarthritides including psoriatic arthritis, ankylosing spondylitis, reactive arthritis, and inflammatory bowel disease-associated spondyloarthritis often involve the skin and may occur before or after diagnosis of these rheumatic diseases. Cutaneous manifestations encompass a wide range of reactions that may have a notable negative impact not only on the physical but especially on the emotional and psychosocial well-being of these patients. Several cutaneous manifestations have been related to rheumatoid arthritis such as subcutaneous nodules including classical rheumatoid nodules, accelerated rheumatoid nodulosis, and rheumatoid nodulosis; vascular disorders like rheumatoid vasculitis, livedo racemosa, and Raynaud’s phenomenon; and neutrophilic and/or granulomatous diseases like pyoderma gangrenosum, Sweet’s syndrome, rheumatoid neutrophilic dermatitis, interstitial granulomatous dermatitis with arthritis, as well as palisaded neutrophilic and granulomatous dermatitis. In juvenile idiopathic arthritis, the main cutaneous manifestations include an evanescent rash, rheumatoid nodules, as well as plaque and guttate psoriasis. Plaque psoriasis is also the main skin disease involved in spondyloarthritides. Furthermore, other forms of psoriasis including guttate, inverse, erythrodermic, pustular, and particularly nail psoriasis may also occur. In addition, a variety of drug-induced skin reactions may also appear in these diseases. Early recognition and understanding of these different dermatologic manifestations together with an interdisciplinary approach are often needed to optimize management of these diseases.

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Abbreviations

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

HLA:

Human leukocyte antigen

DMARDs:

Disease modifying anti-rheumatic drugs

IL:

Interleukin

TNF:

Tumor necrosis factor

RV:

Rheumatoid vasculitis

ND:

Neutrophilic dermatoses

RND:

Rheumatoid neutrophilic dermatitis

PG:

Pyoderma gangrenosum

PMN:

Polymorphonuclear leucocytes

CD:

Cluster of differentiation

NSAIDs:

Non-steroidal anti-inflammatory drugs

PNGD:

Palisaded neutrophilic and granulomatous dermatitis

JIA:

Juvenile idiopathic arthritis

MAS:

Macrophage activation syndrome

Th-1:

T helper 1 cell

GPP:

Generalized pustular psoriasis

AGEP:

Acute generalized exanthematous pustulosis

PPP:

Palmoplantar pustulosis

KOH:

Potassium hydroxide test

VDRL:

Venereal disease research laboratory test

ReA:

Reactive arthritis

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

SAPHO:

Synovitis, acne, pustulosis, hyperostosis, and osteitis

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Chua-Aguilera, C.J., Möller, B. & Yawalkar, N. Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides. Clinic Rev Allerg Immunol 53, 371–393 (2017). https://doi.org/10.1007/s12016-017-8632-5

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