Background/Purpose:

Suppurative Hidradenitis (SH) is an inflammatory skin disease with often disappointing response to treatment. It is a disorder of apocrine glands (axillary, inguinal and anogenital regions) with infection and multiple inflamed nodules, cysts, abscesses and sinus tracts. It has been associated in a 1-4% with spondyloarthropathies and inflammatory bowel disease, possibly due to an innate immune system deregulation. The use of biological disease-modifying antirheumatic drugs (bDMARD) specifically tumor necrosis factor inhibitors has been described as a therapeutic alternative achieving good clinical results in these patients. Objective: To evaluate the prevalence of SH using the SH-questionnaire in patients diagnosed with chronic arthritis treated with bDMARD.

Methods:

This cross-sectional study included 325 patients with a diagnosis of chronic arthritis. Those were recruited from Biological Therapy Unit at the Hospital General Universitario Gregorio Marañón and consecutively attended from January to March of 2015. All patients were treated with full or tapered bDMARD for at least 1 year. The bDMARD dosage tapering had been made in patients with a maintained remission according to their attending rheumatologist and the patient approval. None of patients had a previous SH diagnosis. All patients self-completed the validated SH-questionnaire (Esmann S, et al. Br J Dermatol. 2010 Jul;163(1):102-6, it was considered positive with an affirmative answer and lesions in >1 anatomical location. Patients were classified in peripheral arthritis (PerAR) [rheumatoid arthritis (RA)], psoriatic arthritis (PsA) and peripheral spondyloarthropathies (PerSpA)] and axial spondyloarthropathies (AxSpA). The clinical evaluation was always performed by the same observer. Demographic, clinical and laboratory variables were collected and clinical indices related to each pathology were calculated (DAS28-ESR, DAS28-CRP, SDAI, CDAI, BASDAI, BASFI, ASDAS-CRP).

Results:

SH-positive was observed in 25/325 (7.7% vs. 92.3%) patients. Of these 25 patients, 12 (48%) were female and 13 (52%) were male. The mean age was 52 years (SD ± 12.9) and mean time since diagnosis was 14 years (SD ± 9.3). Twenty-four out of 25 patients had anti-TNF treatment (ETN=10, GOL=7, ADL=6, CTZ= 1). We found that 84% of patients had full and 16% had tapered bDMARD dosage. According to pathology, 13 had PerAR and 12 had AxSpA diagnosis (5.8% vs. 11.8%, p=0.062). Comparing the subtypes of PerAR, we found that 6 patients had PsA and 5 had RA. Evaluating the clinical activity disease, we found 9/13 patients in the PerAR group with clinical remission according to DAS28-ESR and CDAI (p=0.02 for both). Additionally, we found only 4/12 patients in remission in the AxSpA group by BASDAI, BASFI and ASDAS-PCR (p=0.006, p=0.005, p=0.004, respectively).

Conclusion:

We found more SH-positivity in the AxSpA than in the PerAR group, which is consistent with published data. A bDMARD tapered dosage was related to SH-positivity which might be linked to persistent and undetectable inflammation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-suppurative-hidradenitis-in-patients-with-chronic-arthritis-treated-with-full-and-tapered-biological-disease-modifying-antirheumatic-drugs/