THE IMPORTANCE OF HYDRADENITIS SUPURATIVA IN RHEUMATOLOGIC DISEASES

Abstract

Objective: Hidradenitis suppurativa (HS) is a recurrent chronic inflammatory disease of the apocrine glands. It is more common in women, especially after puberty. The primary locations affected are the axillary, inguinal, perianal, and perineal regions, with a painful nodüle and a complex of symptoms ranging from abscesses to sinus formation and hypertrophic scars. Obesity and metabolic syndrome, especially spondyloarthritis, autoinflammatory diseases and some autoimmune diseases are more common in HS patients. In this study, we aimed to determine the etiologic factors, demographic and clinical characteristics of patients with HS who were attending our rheumatology clinic. Material and Methods: This study was performed retrospectively in the Department of Rheumatology between January 2017 and December 2018. Eleven patients diagnosed with HS and over 18 years of age were included in the study. Epidemiological, clinical, and laboratory findings, along with treatment information file records of patients, were obtained through examinations. Results: Of 11 patients diagnosed with HS, 10 were male and one was female. The mean age of the patients was 40.9 years (minumum 22, maximum 57). When evaluated for concomitant rheumatologic diseases, four cases of spondyloarthritis, three of Behcet’s disease, one of Familial Mediterranean Fever, one of rheumatoid arthritis, one of gout and one of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) were diagnosed. Conclusion: HS may be associated with rheumatic diseases. Therefore, a differential diagnosis should be made in patients followed up with the diagnosis of HS in the case of rheumatologic complaints.

Keywords

• Hidradenitis suppuriva
• spondyloarthritis
• Behcet’s disease
• Familial Mediterranean Fever
• SAPHO syndrome

ROMATOLOJİK HASTALIKLARDA HİDRADENİTİS SÜPÜRATİVA’NIN ÖNEMİ

Abstract

Amaç: Hidradenitis suppurativa (HS), özellikle puberte sonrası, kadınlarda daha sık görülen apokrin glandların tekrarlayıcı kronik inflamatuar bir hastalığıdır. Primer tutulum bölgeleri aksiller, inguinal, perianal, perineal bölgeler olan hastalık, ağrılı bir nodülden, abse, sinüs oluşumu ve hipertrofik skarlara kadar değişen bir semptom kompleksinden oluşur. Başta obezite ve metabolik sendrom olmak üzere, spondiloartrit, otoinflamatuar hastalıklar ve bazı otoimmün hastalıklar HS hastalarında daha sık görülür. Bu çalışmamızda romatoloji kliniğimizde takipli olan ve HS tanısı almış hastalarda etyolojik, demografik ve klinik özelliklerin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma retrospektif olarak Ocak 2017-Aralık 2018 tarihleri arasında Romatoloji Bilim Dalında yapıldı. Çalışmaya 18 yaş üzeri HS tanısı konulan 11 hasta dahil edildi. Hastaların epidemiyolojik, klinik, laboratuvar bulguları ve tedavi bilgileri dosya kayıtları incelenerek elde edildi. Bulgular: HS tanısı alan 11 hastanın 10’u erkek, biri kadındı. Hastaların ortalama yaşı 40,9 (en küçük 22-en büyük 57). Eşlik eden romatolojik hastalıklar açısından değerlendirildiğinde, dört seronegatif spondiloartropati, üç Behçet hastalığı, bir Ailevi Akdeniz Ateşi, bir romatoid artrit, bir gut ve bir SAPHO sendromu (sinovit, akne, püstüloz, hiperostoz ve osteit) tanıları mevcuttu. Sonuç: HS’nin romatizmal hastalıklarla birlikteliği gözlenebilir. Bu nedenle HS tanısı ile izlenen hastalarda romatolojik yakınmalar olduğunda tetkik edilerek ayırıcı tanı yapılmalıdır.

Keywords

• Hidradenitis süpürativa
• Spondiloartrit
• Behçet hastalığı
• Ailevi Akdeniz Ateşi
• SAPHO sendromu

References

1. 1. Sellheyer K, Krahl D. “Hidradenitis suppurativa” is acne inversa! An appeal to (finally) abandon a misnomer. Int J Dermatol 2005;44(7):535-40.
2. 2. Jemec GB, Kimball AB. Hidradenitis suppurativa: epidemiology and scope of the problem. J Am Acad Dermatol 2015;73:4-7.
3. 3. Molina-Leyva A, Cuenca-Barrales C. Adolescent-Onset Hidradenitis Suppurativa: Prevalence, Risk Factors and Disease Features. Dermatology 2019;235(1):45-50. 4. Revuz JE, Jemec GB. Diagnosing hidradenitis suppurativa. Dermatol Clin 2016;34(1):1-5.
4. 5. Canoui-Poitrine F, Le Thuaut A, Revuz JE, Viallette C, Gabison G, Poli F, et al. Identification of three hidradenitis suppurativa phenotypes: latent class analysis of a crosssectional study. J Invest Dermatol 2013;133(6):1506-11.
5. 6. Vinkel C, Thomsen SF. Hidradenitis Suppurativa: Causes, Features, and Current Treatments. J Clin Aesthet Dermatol. 2018;11(10):17-23.
6. 7. Pescitelli L, Ricceri F, Prignano F. Hidradenitis suppurativa and associated diseases. G Ital Dermatol Venereol 2018;153(3 Suppl 2):8-17.
7. 8. Chiricozzi A, Giovanardi G, Caposiena Caro DR, Iannone M, De Simone C, Cannizzaro MV, et al. Characterization of comorbid conditions burdening hidradenitis suppurativa: a multicentric observational study. G Ital Dermatol Venereol 2018 Oct 3.
8. 9. Tricarico PM, Boniotto M, Genovese G, Zouboulis CC, Marzano AV, Crovella S. An integrated approach to unravel Hidradenitis Suppurativa etiopathogenesis. Front Immunol 2019;10:892.

9. 10. Kelly G, Hughes R, McGarry T, van den Born M, Adamzik K, Fitzgerald R, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol 2015;173(6):1431-9.
10. 11. Miller IM, McAndrew RJ Hamzavi I. Prevalence, risk factors, and comorbidities of hidradenitis suppurativa. Dermatol Clin 2016;34(1):7-16.
11. 12. Nikolakis G, Kyrgidis A, Zouboulis CC. Is There a Role for Antiandrogen Therapy for Hidradenitis Suppurativa? A Systematic Review of Published Data. Am J Clin Dermatol 2019;20(4):503-13.
12. 13. Kelly G, Prens EP. Inflammatory mechanisms in hidradenitis suppurativa. Dermatol Clin 2016;34(1):51-8.
13. 14. Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and metabolic syndrome-systematic review and adjusted metaanalysis. Int J Dermatol. 2019;58(10):1112-1117.
14. 15. Puig L, Ruiz de Morales JG, Dauden E, Andreu JL, Cervera R, Adán A, et al. Prevalence of ten Immune-mediated inflammatory diseases (IMID) in Spain. Rev Esp Salud Publica. 2019 Mar 25;93. pii: e201903013.
15. 16. Rondags A, Arends S, Wink FR, Horváth B, Spoorenberg A. High prevalence of hidradenitis suppurativa symptoms in axial spondyloarthritis patients: A possible new extraarticular manifestation. Seminars in arthritis and rheumatism. Semin Arthritis Rheum 2019;48(4):611-7.
16. 17. Fauconier M, Reguiai Z, Barbe C, Colosio A, Eschard JP, Salmon JH, et al. Association between hidradenitis suppurativa and spondyloarthritis.Joint Bone Spine 2018;85(5):593-7.
17. 18. Hodak E, Atzmony L, Pavlovsky L, Comaneshter D, Cohen AD. Hidradenitis Suppurativa Is Associated with Familial Mediterranean Fever-A Population-Based Study. J Invest Dermatol 2017;137(9):2019-21.
18. 19. Lima AL , Karl I, Giner T, Poppe H, Schmidt M, Presser D, et al. Keratinocytes and neutrophils are important sources of proinflammatory molecules in hidradenitis suppurativa. Br J Dermatol 2016;174(3):514-21.
19. 20. Ben-Zvi I, Kukuy O, Giat E, Pras E, Feld O, Kivity S, et al. Anakinra for Colchicine-Resistant Familial Mediterranean Fever: A Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Rheumatol 2017;69(4):854-62.
20. 21. Gottlieb J, Madrange M, Gardair C, Sbidian E, Frazier A, Wolkenstein P, et al. PAPASH, Ps APASH and PASS autoinflammatory syndromes: Phenotypic heterogeneity, common biological signature and response to immunosuppressive regimens. Br J Dermatol 2019;181(4): 866-9.
21. 22. Vinkel C, Thomsen S. Autoinflammatory syndromes associated with hidradenitis suppurativa and/or acne. Int J Dermatol 2017;56(8):811-8.
22. 23. Vekic DA, Woods J, Lin P, Cains GD. SAPHO syndrome associated with hidradenitis suppurativa and pyoderma gangrenosum successfully treated with adalimumab and methotrexate: a case report and review of the literature. Int J Dermatol 2018;57(1):10-8.
23. 24. Verma P, Chhabra N. A Comment on Rapid Progression of Hidradenitis Suppurativa in the Lower Leg of a Patient with Psoriasis Vulgaris. Acta Derm Venereol 2012;92(4):447.
24. 25. Sahin MT, Oztürkcan S, Türel-Ermertcan A, Yurtman-Havlucu D, Bilaç C. Behcet’s disease associated with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2007;21(3):4289.
25. 26. Ben David C, Bragazzi NL, Watad A, Sharif K, Whitby A, Amital H, et al. Hidradenitis suppurativa associated with systemic lupus erythematosus: A case report. Medicine (Baltimore) 2018;97(12):e0186.
26. 27. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brasasard A, Burkhart C, et al. North American Clinical Management Guidelines for Hidradenitis Suppurativa: a Publication from the United States and Canadian Hidradenitis Suppurativa Foundations. Part I: Diagnosis, Evaluation, and the use of Complementary and Procedural Management. J Am Acad Dermatol 2019;81(1):76-90. 28. Flood KS, Porter ML, Kimball AB. Biologic Treatment for Hidradenitis Suppurativa. Am J Clin Dermatol 2019;20(5):625-38.
27. 29. Oskardmay AN, Miles JA, Sayed CJ. Determining the Optimal Dose of Infliximab for Treatment of Hidradenitis Suppurativa. J Am Acad Dermatol 2019;81(3):702-8.
28. 30. Matusiak Ł, Jemec GB, Szepietowski JC. Pharmacological development in hidradenitis suppurativa. Curr Opin Pharmacol 2019;46:65-72.