Diagnosis Check-in: The Link Between Hidradenitis Suppurativa and Inflammatory Arthritis

Can a patient with hidradenitis suppurativa develop rheumatoid arthritis? Apparently so, according to researchers writing in JAMA Dermatology this month.

Maria C. Schneeweiss, M.D., of Brigham and Women’s Hospital, Boston, and colleagues found that patients with the inflammatory skin condition hidradenitis suppurativa are indeed at higher risk of developing rheumatoid arthritis and other inflammatory arthritides, such as ankylosing spondylitis and psoriatic arthritis.

Previously, it was known that these patients have a high prevalence of spondyloarthritis, but not for rheumatoid arthritis or other inflammatory arthritides.

Their findings are based on a review of longitudinal claims data of 185 million people between Jan. 1, 2003 and Jan. 1, 2016. The final analysis included 70,697 patients with hidradenitis suppurativa (mean 36.5 years, 78% female) and 141,412 patients without the condition (mean age 38.3 years). The patients with the condition were also more likely to have comorbidities, such as psoriasis and inflammatory bowel disease. Prior to the start of the study, the patients did not have arthritis, but by the close of the study, the patients with hidradenitis suppurativa were found to be at increased risk for developing ankylosing spondylitis (incidence rate, 0.60 vs 0.36 per 1,000); psoriatic arthritis (incidence rate, 0.84 vs 0.58 per 1,000); and, rheumatoid arthritis (incidence rate, 4.54 vs 3.86 per 1,000).

Patients were included in the analysis if they received a hidradenitis suppurativa diagnosis by a dermatologist or three healthcare professionals. Patients with preexisting inflammatory arthritis were not included in the analysis.

RELATED:  Can Hidradenitis Suppurativa Predict Outcomes to Axial Spondyloarthritis?

The incidence of arthritis was low—only two to six additional cases per 10,000 patients with hidradenitis suppurativa (HS) over one year and a half.

“Although the data support a systematic association between HS and subsequent newly diagnosed inflammatory joint disease, the low incremental risk is reassuring. Nevertheless, physicians treating patients with HS should be aware of symptoms suggestive of inflammatory arthritis, including morning stiffness and joint pain or swelling. This study cannot prove a causal relationship between HS and inflammatory arthritis, and further work is needed to elucidate the underlying potential shared pathogenesis of these disorders,” the authors wrote.


Maria C. Schneeweiss, MD; Seoyoung C. Kim, MD, ScD; Sebastian Schneeweiss, MD, ScD; David Rosmarin, MD; Joseph F. Merola, MD, MMSc. “Risk of Inflammatory Arthritis After a New Diagnosis of Hidradenitis Suppurativa.” JAMA Dermatology. March 1, 2020.

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