¹Suad Hannawi,¹Haifa Hannawi

¹Emirates Health Services

Background:

Rheumatoid arthritis (RA) is a chronic polyarthritis autoimmune disease that has many extra-articular manifestations; including skin manifestations. Hidradenitis suppurativa is a suppurative condition of the apocrine sweat glands associated with induration, scarring, destruction of skin appendages, and sinus formation. Hidradenitis suppurativa had not been reported with RA. in the clinical case description we report a clinical case of hidradenitis suppurativa that occurs in the setting of RA.

Material(s) and Method(s):

Mr. X is a 46 years old man, who was diagnosed in his childhood to have juvenile RA. Mr. X is one of 5 siblings who had been diagnosed with juvenile RA. Mr. X was under the care of another hospital. At the first presentation to one of the Emirates Health Services (Ministry of Health and Prevention-United Arab Emirates) rheumatology clinic, he reported recurrent boils in the buttock and groin regions for 7 months. The boils are painful and break open releasing fluid or pus. As well it required several admissions to the surgical unit for the boils’ excisions. After excision scars are left on the skin. Examination revealed short stature and growth retardation secondary to long-term steroid overuse. Hands examinations showed deformed hands. The right hand showed fixed flexion of all the metacarpophalangeal joints (MCPJS). Left hand showed Z-thumb deformity and swan neck deformity; extension of the proximal interphalangeal joints and flexion of the distal interphalangeal joints of the left 2nd, 3rd, 4th, and 5th fingers. There were 2 boils at the buttock and a number of scars of the previously excised boils investigations showed high erythrocytes sedimentation rate (ESR) of 143 mm/hr. and C-reactive protein (CRP) of 71 mg/dl, a sterile culture of the pus obtained from the boils, and negative rheumatoid factor (RF). Mr. X had been diagnosed to have hidradenitis suppurative which had been confirmed by the dermatology consultation.

Results:

Dermatology consultation confirmed the diagnosis of hidradenitis suppurativa.

Conclusion:

Hidradenitis suppurative occurs with RA. Realizing this combination is important to select the proper medications that can treat both medical conditions.