Rheumatoid arthritis and spondyloarthritis are inflammatory joint disorders with an autoimmune pathogenesis and systemic involvement. The skin is one of the most frequently affected extraarticular sites with a number of manifestations or distinct diseases, including common conditions, such as
rheumatoid nodules and
psoriasis, and
rare diseases like neutrophilic
dermatoses. The latter are clinically characterised by polymorphic lesions, including pustules,
bullae,
abscesses, papules, nodules, plaques and
ulcers, and histologically by neutrophil-rich inflammatory infiltrates. Inflammatory joint disorders and neutrophilic
dermatoses share a number of pathophysiological features related to their
cytokine overexpression profile. Moreover, any organ system can be potentially involved in neutrophilic
dermatoses, giving rise to the concept of neutrophilic disease. Among the extracutaneous manifestations of neutrophilic disease, joint involvement is regarded as the most common. It is not associated with erosions and disability and usually responds to treatment for skin involvement, consisting of systemic
corticosteroids and, in refractory cases,
immunosuppressants or biologics.
Arthritis may also be the initial manifestation of
rheumatoid arthritis or spondyloarthritis, which has a chronic or recurrent course and requires a continuous treatment with synthetic or
biologic disease-modifying
anti-rheumatic drugs. If not properly treated, they may be associated with disability and reduced quality of life. Skin lesions occurring during the course of
rheumatoid arthritis and spondyloarthritis require a multidisciplinary approach envisaging the collaboration of dermatologists and rheumatologists in order to achieve early diagnosis and treatment. Several
biomarkers may help the clinician in the differential diagnosis of
arthritis while histology is pivotal for the correct classification of the
skin disease. However, in some cases, only regular follow-up allows a definite diagnosis. In this review article, we focus on the prototypic neutrophilic
dermatoses like
pyoderma gangrenosum,
Sweet's syndrome,
hidradenitis suppurativa and their syndromic forms as well as on their articular involvement, providing a simple approach for their diagnosis and
therapy.