AB1132 Panniculitis in rheumatology practice: specific features of clinical course and outcomes
Authors: B. Belov, N. Savushkina, O. Egorova
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Panniculitis (Pn) is a heterogenic group of inflammatory diseases with predominant involvement of subcutaneous adipose tissue and may occasionally be seen in clinical practice by many specialists. Although, fever, skin symptoms and joints involvement alongside with pronounced rise of acute phase inflammation reactants are the reasons for referral to a rheumatologist. At the same time absence of clear diagnostic algorithm would result in delayed diagnosis and, consequently, inadequate treatment. <h3>Objectives</h3> To assess clinical course and clinical outcomes of panniculitis in current rheumatology practice. <h3>Methods</h3> The study included 209 pts on the record at VA Nasonova Research Institute of Rheumatology during 2009–2016 yy. (185 females and 24 males, aged 17–80 years) with referral diagnosis "Erythema nodosum. Non-differentiated panniculitis» and disease duration from 1 week to 25 years. Patients' assessment included general clinical examination, <i>serological</i> and immunological <i>tests, histological and immunohistochemical analyses,</i> chest CT scan, Doppler ultrasonography of the lower extremity veins<i>, and tuberculin skin test. Outcomes were evaluated in</i> 1–6 years. <h3>Results</h3> Secondary to underlying non- rheumatic condition Pn was identified in 23 pts. The most prevalent Pn types in remaining 186 cases were: erythema nodosum (EN) (121pts), lipodermatosclerosis (LDS)<sup>38</sup> and Weber-Christian disease (WCD).<sup>18</sup> Symmetrical distribution of nodules over upper and lower extremities (ULE) was characteristic for 93% of all EN cases. In LDS populations 68% cases had increased mean body mass index (BMI), 79% – <i>chronic venous insufficiency</i> (CVI), 60% – asymmetric distribution of lesions, mostly over medial leg (92%). In WCD patients the nodules were covering all ULE surfaces, and in 14 nodules were found on the trunk. The three Pn types had certain differences in the clinical course: high clinical and lab activity was documented in <i>Löfgren syndrome and WCD pts</i>. Asymmetric distribution of nodules on the legs was characteristic for LDS, nodules on the trunk were specific for WCD. The highest recurrence rate was documented in WCD pts (39,7 per 100 patient-years), the lowest—in <i>Löfgren syndrome pts</i> (15,3 per 100 patient-years). The probability of EN recurrence in <i>Löfgren syndrome pts</i> was significantly higher in subjects older than 40 y (OR 3,81; p=0,03), in subjects with late (≥3 months from EN onset) initiation of treatment (OR 8,94; p=0,0008) and in subjects with indurations&gt;5 cm in size (OR 3,65; p=0,03). The probability of LDS recurrence was significantly higher in pts with confluent nodules, forming conglomerate masses (OR 4,33; p=0,037), and pts taking hydroxychloroquine at ≤200 mg/day during ≥6 months (OR 5,25; p=0,019). <h3>Conclusions</h3> Comprehensive examination is needed to identify the clinical type of Pn. Symmetrical involvement of all extremities is characteristic for EN in young subjects. Asymmetric nodular rash over lower extremities in subjects with abnormal BMI and CVI is specific for LDS. CWD usually presents with nodular rash on the trunk. Identified risk factor for EN and LDS recurrence should be taken into consideration while writing a treatment plan. <h3>Acknowledgements</h3> The study had no sponsorship. <h3>Disclosure of Interest</h3> None declared