Interdisciplinary Approaches to Overlap Disorders in Dermatology & Rheumatology

Foreword
Preface
Contents
Contributors
1: Evaluation of the Integumentary and Musculokeletal Systems: An Approach to the Interdisciplinary Examination for Overlap Diseases
Introduction
General Recommendations
Distribution
Color
Shape or Configuration
Scaling
Consistency
Scalp/Hair/Nails/Oral Mucosa
Rheumatologic Musculoskeletal Examination
Joint Examination
Muscle Examination
Conclusion
2: Serologic Evaluation in the Rheumatology-Dermatology Overlap Patient
Interdisciplinary Introduction
Erythrocyte Sedimentation Rate and C-reactive Protein
Antibodies in Rheumatologic Disease – General Principles
Anti-nuclear Antibody
SLE-Associated Serologies
Systemic Sclerosis (Scleroderma)
Dermatomyositis
Psoriatic Arthritis
Vasculitis
Still’s Disease
Sarcoidosis
Lyme disease
Summary
Suggested Reading
References
3: Cutaneous Lupus
Interdisciplinary Introduction
Epidemiology & Classification
Epidemiology
Classification of Cutaneous Lupus Erythematosus
Gilliam Classification (Table 3.1)
Other Approaches to CLE Subgrouping
LE-Nonspecific Skin Changes (Table 3.2)
CLE Association with SLE
Pathogenesis of Cutaneous Lupus Erythematosus
Genetic Factors
Ultraviolet Light and Apoptosis
Innate Immunity
Inflammatory Cells
Inflammatory Cytokines and Chemokines
Clinical Features
Acute Cutaneous Lupus Erythematosus (ACLE)
Subacute Cutaneous Lupus Erythematosus (SCLE)
Discoid Lupus Erythematosus (DLE)
Cutaneous Lupus: Additional LE-Specific Skin Variants
Lupus Erythematosus Tumidus (Tumid Lupus)
Lupus Erythematosus Panniculitis/Lupus Profundus
Chilblain Lupus
Neonatal Lupus
Lupus-specific Vesiculobullous Disease
Bullous SLE (BSLE)
Vesiculobullous Disease Occurring as Severe Variants of ACLE, SCLE, and Rarely, DLE.
Non-specific Cutaneous Lesions of LE
Diagnostic Considerations
Diagnosis of Cutaneous Lupus
Histopathology
Antibody Deposits in the Skin (DIF)
Autoantibodies
Evaluation for Systemic Disease
Principles of Management
Prevention/Patient Education
Sun Protection
Smoking Cessation
Camouflage
Local Therapy
Topical Steroids
Calcineurin Inhibitors
Intralesional corticosteroids
Laser
Systemic Therapy
Antimalarials
Antimalarial-resistant Disease
Immunosuppressant Agents
Methotrexate
Mycophenolate Mofetil (MMF) or Mycophenolate Sodium
Azathioprine
Systemic Corticosteroids
Immunomodulators
Dapsone
Thalidomide
Lenalidomide
Oral Retinoids
Other Therapies
Disease and Comorbidity Assessment (Table 3.6)
Systemic Screening
Malignancy Risk
Pregnancy
Summary
References
4: Dermatomyositis
Interdisciplinary Introduction
Epidemiology and Risk Factors
Classification
Clinical Presentation
Skin Disease
Classic Features
Rare Presentations of Cutaneous DM
Cutaneous Signs of Interstitial Lung Disease
Cutaneous Signs of Internal Malignancy
Histopathology
Differential Diagnosis
Muscle Disease
Classic Presentation
Histopathology
Electromyography
Imaging
Differential Diagnosis
Systemic Disease
Pulmonary Manifestations
Interstitial Lung Disease
Pulmonary Arterial Hypertension
Cardiac Manifestations
DM-Specific Cardiac Involvement
Coronary Artery Disease
Thromboembolic Disease
Joint Manifestations
Renal Manifestations
Rare Manifestations
Cancer
Principles of Management
Overview
Behavioral Change
Physical Medicine and Rehabilitation
Topical Agents
Topical Corticosteroids
Topical Calcineurin Inhibitors
Systemic Medications
Antimalarials
Methotrexate
Systemic Corticosteroids
Mycophenolate Mofetil
Intravenous Immunoglobulin
Rituximab
Cyclosporine
Tofacitinib
Tacrolimus
Nonsteroidal Anti-inflammatory Drugs
Azathioprine
Leflunomide
Dapsone
Thalidomide
Cyclophosphamide
Special Cases: Calcinosis Cutis and Ulceration
Summary
References
5: Morphea
Interdisciplinary Introduction
Nomenclature
Epidemiology
Pathogenesis
Evidence for Autoimmunity
Genetic Susceptibility
Environmental Triggers
Histopathology
Classification
Peterson Criteria (1995)
Laxer and Zulian (2006)
Clinical Features
Plaque Morphea
Generalized Morphea
Linear Morphea
Deep Morphea
Disabling Pansclerotic Morphea
Eosinophilic Fasciitis
Mixed Morphea
Rare Variants
Natural History
Disease Assessment
Comorbidities
Approach to Screening and Monitoring
Principals of Management
Topical Therapy
Phototherapy
Systemic Therapy
Summary
References
6: Systemic Sclerosis
Interdisciplinary Introduction
Nomenclature
Epidemiology
SSc Classification Criteria
SSc Subsets
Clinical Features
Cutaneous
Vascular
Raynaud’s Phenomenon
Digital Ischemia
Gastrointestinal
Oropharynx
Esophagus
Gastric
Small Intestine
Large Intestine and Anorectum
Liver
Pulmonary
Interstitial Lung Disease
Pulmonary Hypertension
Cardiac
Renal
Musculoskeletal
Pathophysiology of Systemic Sclerosis
Vascular Injury and the Initiation of SSc
Autoimmunity
Fibrosis
Risk Factors for Systemic Sclerosis
Genetic Risk Factors
Occupational and Environmental Risk Factors
Autoantibodies
Diagnostic Considerations
Physical Examination
Laboratory Testing
Cardiopulmonary Studies
Other Studies
Disease and Comorbidity Assessment
Measurement of Disease Activity and Severity
Monitoring
Comorbidities
Management of SSc
Organ-Specific Therapy
Skin Disease
Vascular: Raynaud’s Phenomenon and Digital Ischemic Ulcers
Gastrointestinal
Pulmonary
Interstitial Lung Disease
Pulmonary Arterial Hypertension
Renal
Musculoskeletal
Immune Modulation and Targeted Therapies
Survival
Summary
References
7: Psoriasis and Psoriatic Arthritis
Interdisciplinary Introduction
Epidemiology & Classification
Pathogenesis
Clinical Features
Diagnostic Considerations
Screening Tools
Disease and Comorbidity Assessment
Gastrointestinal Disease
Autoimmune Ophthalmic Disease
Psychiatric Disease
Metabolic Syndrome and Cardiovascular Disease
Principles in Management
Disease Outcome Measures
Minimal Disease Activity State and Treat to Target
Therapeutic Interventions
Lifestyle Modifications
Topical Therapy for Psoriasis
Phototherapy
Oral Therapy
Non-steroidal Anti-inflammatory Drugs and Corticosteroids
Methotrexate
Leflunomide
Sulfasalazine
Acitretin
Cyclosporine
Apremilast
Biologic Therapy
TNF-α Antagonists
Etanercept
Adalimumab
Infliximab
Golimumab
Certolizumab
Risks and Benefits of Using TNF-α Antagonists
IL-12 / IL-23 Antagonists
Ustekinumab
Guselkumab
Risankizumab and Tildrakizumab
Safety Concerns with IL-12/23 Antagonists
IL-17 Antagonists
Secukinumab
Ixekizumab
Brodalumab
Safety Concerns with IL-17 Antagonists
Janus Kinase Inhibitors
Safety Concerns with JAK Inhibitors
T Cell Costimulation Blockade
Safety Concerns with T Cell Co-stimulation Blockade
Monitoring in Biologics
Combining Psoriasis Therapies
Cost of Psoriasis and Psoriatic Arthritis Therapies
References
8: Vasculitis
Interdisciplinary Introduction
Nomenclature and Classification of Vasculitis
Pathophysiology and Clinical Features
Small-Vessel Vasculitis
Medium-Vessel Vasculitis
Extracutaneous Manifestations
Types of Vasculitis with Skin Involvement
Cutaneous Small-Vessel Vasculitis/Small-Vessel Vasculitis of the Skin
Cutaneous Manifestations
Systemic Findings
IgA Vasculitis
Cutaneous Manifestations
Systemic Findings
Urticarial Vasculitis
Cutaneous Manifestations
Systemic Findings
Cryoglobulinemic Vasculitis
Cutaneous Manifestations
Systemic Findings
Granulomatosis with Polyangiitis (Wegner’s)
Cutaneous Manifestations
Systemic Findings
Microscopic Polyangiitis
Cutaneous Manifestations
Systemic Findings
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)
Cutaneous Manifestations
Systemic Findings
Polyarteritis Nodosa
Cutaneous Manifestations
Systemic Findings
Giant Cell Arteritis and Takayasu Arteritis
Initial Evaluation of Patients with Possible Vasculitis
Skin Biopsy
Biopsy Selection and Performance
Histologic Findings in Cutaneous Vasculitis
Common Pitfalls in Using Skin Pathology to Evaluate Possible Vasculitis
Review of Systems and Medical History
Laboratory Studies
Basic Tests That Should Be Ordered in All Patients
Urinalysis with Microscopic Examination
Basic Metabolic Panel
Complete Blood Count
Other Laboratory Tests Useful in Select Cases
Liver Function Tests
Acute Phase Reactants
Serologic Tests of Autoimmunity
Antineutrophilic Cytoplasmic Antibodies (ANCAs)
Anti-Nuclear Antibodies
Rheumatoid Factor
Complement Levels
Cryoglobulins
Serum Protein Electrophoresis (SPEP) and Immunofixation
Serologic Tests for Infections
Urine Drug Screen
Diagnostic Imaging Studies in the Evaluation of Possible Vasculitis
Chest Imaging
Sinus and Upper Airway Imaging
Catheter-Based Angiography, MR Angiography, and CT Angiography
Nerve Conduction Studies and Electromyography
Workup and Treatment of Specific Vasculitides with Skin Involvement
Cutaneous Small-Vessel Vasculitis/Small-Vessel Vasculitis of the Skin
Diagnostic Evaluation
Treatment
IgA Vasculitis
Diagnostic Evaluation
Treatment
Urticarial Vasculitis
Diagnostic Evaluation
Treatment
Cryoglobulinemic Vasculitis
Diagnostic Evaluation
Treatment
Granulomatosis with Polyangiitis (Wegener’s)
Diagnostic Evaluation
Treatment
Microscopic Polyangiitis
Diagnostic Evaluation
Treatment
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)
Diagnostic Evaluation
Treatment
Polyarteritis Nodosa
Diagnostic Evaluation
Treatment
Referral and Coordination of Care
Summary
References
9: Sarcoidosis
Interdisciplinary Introduction
Epidemiology & Risk Factors
Pathogenesis
Clinical Features
Pulmonary Sarcoidosis
Cutaneous Sarcoidosis
Other Organ Involvement
Specific Sarcoidosis Phenotypes
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Treatment for Cutaneous Sarcoidosis
Treatment of Pulmonary Sarcoidosis
Summary
References
10: Reactive Erythemas and Panniculitides in Connective Tissue Disease
Interdisciplinary Introduction
Erythema Nodosum, Erythema Induratum, and Connective Tissue Panniculitides
Erythema Nodosum
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Histopathology
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Erythema Induratum/Nodular Vasculitis
Key Summary Capsule Bullets
Classification
Clinical Features
Principles of Management
Lupus Erythematosus Panniculitis
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Dermatomyositis-Associated Panniculitis
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Panniculitis of Sclerosing Disorders
Key Summary Capsule Bullets
Classification
Clinical Features
Principles of Management
Pyoderma Gangrenosum
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Sweet Syndrome
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Palisaded Neutrophilic Granulomatous Dermatitis and Interstitial Granulomatous Dermatitis
Palisaded Neutrophilic Granulomatous Dermatitis
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Interstitial Granulomatous Dermatitis and Interstitial Granulomatous Drug Reaction
Key Summary Capsule Bullets
Classification and Epidemiology
Pathogenesis
Clinical Features
Interstitial Granulomatous Dermatitis
Interstitial Granulomatous Drug Reaction
Diagnostic Considerations
Disease and Comorbidity Assessment
Principles of Management
Summary
References
11: Iatrogenic Disease and Drug Induced Toxicities Related to Anti-Inflammatory and Immunomodulatory Agents
Interdisciplinary Introduction
Toxicities of Anti-Inflammatory and Immunomodulatory Agents
Antimalarials
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Azathioprine
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Cyclosporine
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Dapsone
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Mycophenolate Mofetil
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Methotrexate
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Tumor Necrosis Factor Inhibitors
Mechanism of Action
Cutaneous Side Effects
Extracutaneous and Systemic Side Effects
Drug-Induced Lupus Erythematosus and Drug-Induced Dermatomyositis
Drug-Induced Lupus Erythematosus
Drug-Induced Dermatomyositis
Summary
References
Index