The Skin and Disorders of the Musculoskeletal System

Abstract

Abstract Combined dermatology/rheumatology clinics are valuable for patients with complex disease. Direct questioning about musculoskeletal symptoms should complement a dermatological and occupational history. Musculoskeletal examination includes posture and gait, localisation of pain, the presence and pattern of joint swelling, deformity or restricted movement, and muscle wasting or weakness. Specific patterns of skin and joint involvement are seen in infective arthropathies, including the acute spondylarthritis that may follow a genitourinary or gastrointestinal infection. Rheumatoid arthritis affects the skin in several ways including subcutaneous nodules, vasculitis, neutrophilic dermatosis and leg ulceration. Metabolic disorders, including alkaptonuria and tophaceous gout, affect both skin and joints. Autoinflammatory disorders may be hereditary or acquired (including acne and hidradenitis suppurativa). Relapsing polychondritis presents as recurrent chondritis of the pinnae, nasal cartilage or respiratory tract, eye inflammation and a seronegative inflammatory arthritis. Skin reactions to antirheumatic drugs are common and may be severe, e.g. DRESS, Stevens–Johnson syndrome and toxic epidermal necrolysis.