When do rashes indicate a rheumatological process?

It is known that everything that appears on the skin is "superfluous"; in the body, and thus he gets rid of it. It has become a habit to treat rashes and skin problems exclusively with a dermatologist. But dermatologists know that when even a small rash is accompanied by a violation of well-being and other symptoms, then consultation of an adjacent specialist is necessary. What rashes and in combination with what symptoms should alert a dermatologist? When do you need a consultation with a rheumatologist?

What is Still's disease? Causes of lymphadenopathy

Still's disease was described as early as the end of the 20th century. For a long time, the clinic of the disease was regarded as a juvenile form of rheumatoid arthritis, since the disease was detected in adolescents under the age of 16 years. But after the description of the disease began to notice the manifestations of the disease in adults. Men and women are equally susceptible to developing the disease. The prevalence of the disease is 1 case per 100 thousand of the population.

Still's disease has no specific symptoms, so patients are often diagnosed with sepsis, and bacteriological blood cultures are negative. Some cases of Still's disease were first treated by doctors as "fever of unknown origin." Also, the disease is known for severe lymphadenopathy.

The nature of the onset of the disease and manifestations (acute onset, fever, leukocytosis and lymphadenopathy) indicate the cause of an infectious origin. But the causative agent of the process has not been identified. In some cases, rubella virus, cytomegalovirus, parainfluenza virus, Epstein - & nbsp; Barr, as well as mycoplasmas and Escherichia.

The theory of hereditary predisposition, as well as the theory of the autoimmune origin of the disease, exists, but has not been proven.

Still's disease symptoms. How to recognize a small rash?

Clinically, Still's disease is manifested by several major syndromes.

• Fever. With Still's disease, an increase in temperature has some features. Thus, an increase in temperature is observed in the evening to high numbers, while in the morning and afternoon the temperature decreases or is generally within the normal range. In this regard, the patient feels much better during the day.
• Rashes. Elements of a small rash are represented by flat pink papules or maculae. The rash appears at an altitude of temperature and is localized on the proximal limbs and on the trunk. Such a small rash on the face is rare. Sometimes rashes rise above the level of the skin and appear in places of squeezing or permanent injury to the skin (Koebner phenomenon). Also, a small rash may be accompanied by itching. The rash is difficult to identify by the patients themselves, as it has a pink color, is often not accompanied by subjective sensations, and periodically disappears. Sometimes a doctor has to apply heat to the skin to detect a small rash, for example, apply  warm wipes.
• Articular syndrome. At the beginning of the disease, against the background of high temperature, the joints begin to hurt. Later, the process affects several joints. Polyarthritis in Still's disease affects the knee, ankle, elbow, wrist, hip, temporal – jaw and metatarsus – phalanx joints. Arthritis of the interphalangeal joints makes it possible to differentiate the disease from rheumatic fever, rheumatoid arthritis and systemic lupus erythematosus.
• Cardily – pulmonary manifestations. Manifested in the form of pericarditis or pleurisy. Sometimes pneumonia develops. Myocarditis, cardiac tamponade, infective endocarditis and respiratory distress – syndrome are rare.
• Sore throat. Occurs in most patients with Still's disease and is characterized by a burning sensation in the throat, is permanent.
• Loss of lymphoreticular organs. It manifests itself in the form of hepatosplenomegaly and lymphadenopathy. There is also lymphadenitis. Lymph nodes are enlarged and soldered to the surrounding tissues, which should alert the oncologist.

Diagnosis of Still's disease. Treatment of lymphadenopathy and small rash

There is no specific diagnostic, so the diagnostic search is based on the elimination method. In Still's disease, there is pronounced leukocytosis in the blood, accelerated ESR. In the biochemical blood test, proteins, ferritin, CRP, serum amyloid A are elevated. At the same time, antinuclear & nbsp; and rheumatoid factors, and bacterial blood cultures are negative. This is essential for the diagnosis of Still's disease.

To confirm the diagnosis, an X-ray examination of the affected joints, a biopsy of the lymph node, an ultrasound of the heart and pleural cavity, and an ECG are performed. A characteristic feature of Still's disease is lymphadenopathy.

The disease should be differentiated from psoriatic arthritis, lymphoma, dermatomyositis, systemic vasculitis, tuberculosis, sarcoidosis and granulomatous hepatitis.

Still's disease is treated with non-steroidal anti-inflammatory drugs, the course of which lasts up to 3 months. In severe cases, glucocorticosteroids are prescribed.

The outcome of the disease can be either a spontaneous recovery or a transition to a chronic form, which can give relapses. Relapses are also manifested by the presence of a small rash and lymphadenopathy.