Joint pain with rash
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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There are multiple diseases characterized by joint pain with a rash. Here are a few:
Erythema infectiosum is a lacy appearing rash that occurs in people infected with human parvovirus B19 infection. This virus also causes a polyarticular arthritis that may be self-limited... or in rare instances becomes chronic and look like rheumatoid arthritis.
Facial rashes that have the appearance of “slapped cheeks” may also be caused by human parvovirus B19 infection.
A malar rash – appearing across the cheeks and bridge of the nose -can be seen with systemic lupus erythematosus (SLE), human parvovirus B19 infection, Lyme disease, rosacea, seborrhea, and dermatomyositis. While joint pains usually don’t occur with rosacea or seborrhea, they are a prominent symptom in the other diseases.
Plaques, which are raised plateaus of rash occurring in the scalp, navel, and gluteal cleft are a typical finding in patients who have psoriasis. This disease is characterized by a severe deforming arthritis.
Heliotrope rashes which are purple appearing rashes that occur across the eyelids are seen in patients with dermatomyositis, an autoimmune muscle disease which also has a prominent joint component.
Erythema chronicum migrans is the classic “bulls-eye” rash seen in Lyme disease.
Erythema marginatum rheumaticum is an odd rash with irregular borders noted in patients with rheumatic fever.
Erythema nodosum are large raised red painful bumps usually occurring on the shins in patients with sarcoidosis and Crohn's disease.
Pyoderma gangrenosum is a serious ulcerated rash sometimes seen in patients with inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, anklyosing spondylitis, sarcoidosis, and Wegener's granulomatosis.
Palpable purpura – small purple raised dots can be a sign of hypersensitivity vasculitis, Schönlein- Henoch purpura, polyarteritis nodosa.
Livedo reticularis is a lacy appearing skin condition that is often found in patients with antiphospholipid-antibody syndrome.
Vasculitis of the skin – autoimmune skin rashes- are typically seen in patients who have cholesterol embolus syndrome.
Keratoderma blennorrhagicum is an unusual scaly skin condition affecting the soles of the feet and sometimes the palms of the hands in patients with reactive arthritis and psoriatic arthritis.
Discoid skin lesions which are plaque-like skin rashes can be found in patients who have discoid lupus erythematosus, systemic lupus, and sarcoidosis.
Gottron's papules or plaques occurring across the knuckles are typically seen in patients who have dermatomyositis.
Vesicular pustules on an erythematous (red) base occurring in a young sexually active person who also has a swollen knee or wrist should make one suspicious of gonococcal arthritis.
Viral arthritis of different sorts may be associated with a rash.
Drug- induced arthritis, termed "serum sickness", is often accompanied by a rash. This condition occurs in people treated with many types of medications. A common scenario is a person with a urinary tract infection treated with sulfa drugs.
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