Spondyloarthropathy Associated with Hidradenitis Suppurativa and Acne Conglobata

Abstract

Studies were done on 10 patients with hidradenitis suppurativa or acne conglobata who developed arthritis. In contrast to patients with acne fulminans and arthritis, all these subjects were adults > 22 yr of age; 9 were black and 4 were women. Nine patients had episodic inflammatory oligoarthritis affecting mainly larger joints of the upper and lower extremities. Eight patients had roentgenographic evidence of peripheral arthritis, 4 with erosions. Nine had clinical axial arthropathy but roentgenograms showed abnormalities of the axial skeleton in all 10 patients. Pyoderma gangrenosum, erythema nodosum, conjunctivitis, urethritis, and oral and penile ulcers occurred in some patients. Rheumatoid factor was negative in all patients; the erythrocyte sedimentation rate was elevated in 9; 5 had chronic anemia; 4 had circulating immune complexes, and complement components were elevated in 4. There was no increased incidence of HLA-B27 or other HLA-B7 cross-reacting antigens. A temporal relation of skin and joint disease activity was suggested. Thus, spondyloarthropathy may be associated with hidradenitis suppurativa and acne conglobata. Clinical and laboratory manifestations suggest the arthropathy may be reactive to chronic cutaneous infection.