A retrospective case series of 12 patients with chronic reactive arthritis with emphasis on treatment outcome with biologics.

BACKGROUND: Patients with reactive arthritis frequently present to dermatologists. However, there is paucity of information regarding its clinical aspects and management in dermatological literature. OBJECTIVE: To review the clinical features and management of patients with chronic reactive arthritis admitted to the dermatology department of a teaching hospital. METHODS: This was a retrospective analysis of patients with reactive arthritis admitted to the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India from January 2016 to February 2018. RESULTS: There were 12 males (disease duration 9-180 months). Biologics were used in 9 (75%) patients on 16 different occasions, the most frequent being infliximab (n = 10 times), followed by adalimumab (n = 3), etanercept, secukinumab and itolizumab (n = 1 each), in combination with other systemic agents. Response rate with treatment regimens including biologics (69% responders, 31% partial responders) was statistically significantly better than those without biologics (27% responders, 46% partial responders, 27% nonresponders; P = 0.036), using a composite measure assessing improvement in skin and joint symptoms. Biologics were discontinued on 50% of the occasions, after a median of 3.5 months (range 1.5-7.5 months) because of satisfactory response (n = 4), therapeutic fatigue (n = 3) or adverse event (n = 1). After biologic discontinuation, the response was sustained for a median of 5 months (range 3-6 months) before disease exacerbation. The number of treatment switches increased with the follow-up duration (median three switches per patient, range 1-8). The median follow-up duration was 10.5 months (range 4-76 months). CONCLUSION: Biologics produce rapid improvement in skin and joint symptoms in chronic reactive arthritis, but the response is not long-lasting. Patients with chronic reactive arthritis have a waxing and waning course despite regular treatment. LIMITATIONS: The limitations are retrospective design, small sample size and lack of a validated outcome measure.

Unilateral Blaschko-linear eruption with Gottron-like papules: blaschkoid lupus erythematosus or dermatomyositis?

A 6-year-old boy presented with dusky erythematous plaques in linear and whorled pattern over limbs and trunk for the past 1 year along with subcutaneous nodule on the left cheek of 3 months duration. He also had Gottron-like and inverse Gottron-like papules on hands. Histology from truncal lesion showed interface dermatitis with superficial and deep perivascular and periappendageal infiltrate suggestive of discoid cutaneous lupus erythematosus (CLE), while biopsy from facial nodule revealed features of lupus panniculitis. The connective tissue disease workup showed only antinuclear antibody positivity (2+, 1:100 dilution). There was no clinical or investigational evidence of myositis as part of dermatomyositis (DM) workup. A final diagnosis of Blaschko-linear CLE was made, since Gottron-like and inverse Gottron-like papules can be found in CLE as well. The present case highlights the rarity of presentation of CLE along Blaschko lines and overlapping features of Blaschko-linear CLE with DM.