Arthritis & its associated skin problems

by Dr. Raju Shah

When a patient of Arthritis sees a doctor usually he/she is in pain, agony & discomfort During session with doctor lots of attention is given or provided by a patient to his joint complaints. It will be of great help, if patient gives history of his previous & present skin problems. This helps in arriving very close to initial diagnosis. On other hand medical personnel should also pay more attention during examination of the skin, nails, hair, genitals.

I would only discuss some common skin problems with Arthritis.

Most common is Rheumatoid Arthritis, psoriatic arthritis, system lupus arythematosus (Sle), Reiters arthritis etc.

Rheumatoid Arthritis – Patient would have following skin problem. (These problems are due to deposition of Immune complex Igm & C3 in vessel)

One must remember all patients would not have all the symptoms. Depending upon the chronicity of disease symptoms & signs vary from patient to patient.

Following are classial signs & symptoms

• Subcutaneous Nodules over elbows & other joints.
• Papules over finger pulp & nail in early stage ,latter on Ulcer over finger tips & Gangrene.
• Urticaria & purpura.
• Bullous Eruption.
• Liver palm (bright red)
• Subcutaneous nodule over body.
  Hairs & Mucosa are usually not involved.

Psoriasis – Arthritis is usually of small joints & can be also of lower back and distal interphalangeal joints.

• Skin lesion – Extensor aspects of body i.e. elbow,knee outer aspect of hands, back is involved. Skin shows red scaly plaques usually asymptomatic.
• Scalp – appears as long standing dandruff not responding to various shampoos & treatments.
• Palm & Soles are affected. It appears like a case of allergy to soaps detergents, chemicals
• Generalised pus filled boils called as pustular psoriasis associated with fever & toxic symptoms.
• Erythroderma & exfoliative dermatitis in which whole body is involved.
• Nails changes are tiny dots over nails (pitting over nail) Nails become thick, they get separated & become distorted.
  Hairs & mucosa are not involved.

Systemis Lupus Erythermatosus & connective tissue disorders.

• Erythema (Red rash) over butter fly area on face.
• Sun allergy – Face, hands & exposed skin.
• Changes due to vasculitis, Palmar erythema
  1)Peri nail erythema.
  2)Aphthous mouth ulcer.
  3)Painful punch out ulcer.
  4)Purpura ecchymosis.
  5)Gangrene.

Reiter Syndrome – Arthritis, conjunctivitis & Urethritis & skin lesions Clinically

• Looks like psorisis
• Genital Balanitis.
• Nail distorted.
• Calcaneal spur.

Usually drug given for Arthritis also clear skin Iesions. In few cases, local application of cream & ointments are required.