The Rheumatologist—November 1, 2014
Dermatologists may diagnose and treat patients with conditions that span a variety of specialties, but rheumatology is at the top of the crossover list.
The crossover reaches into three main areas, says rheumatologist Susan M. Goodman, MD, an associate attending physician at the Hospital for Special Surgery in New York. First, there’s systemic rheumatic disease with major skin manifestations, such as systemic lupus erythematosus (SLE), dermatomyositis and scleroderma. Seventy percent of SLE patients will have a rash at some point, Dr. Goodman says. The other conditions can lead a patient to develop inflammatory skin features.
Next, there are inflammatory joint diseases, in which psoriatic arthritis emerges as the most prominent. “As many as 30% of patients attending a psoriasis clinic have evidence of psoriatic arthritis when systematically examined. In these conditions where systemic features may be prognostically significant, a collaborative approach is optimal,” Dr. Goodman says. There’s also rheumatoid arthritis, in which leg ulcers or splinter hemorrhages can indicate vasculitis as a complication of the disease, Dr. Goodman says.
Finally, infections can present with a rash that is a complication from a disordered immune system of the rheumatic diseases or because of the immunosuppressant medications used to treat these illnesses, Dr. Goodman added.
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