Background Panniculitis (Pn) is a group of heterogeneous rheumatic diseases characterized by inflammation of the subcutaneous fat (SF), disorders of the locomotor system and internals. Pn may be one of the rheumatic disease (RD) symptoms.
Objectives To describe the symptoms of Pn associated with RD.
Methods We studied 548 patients (76 men, 472 women), mean age 39±17 [16;75], with the referral diagnosis of erythema nodosum (EN) or panniculitis. Patient evaluation included physical examination, lab tests (levels of α1-antitrypsin, amylase, lipase, trypsin, ferritin, creatine phosphokinase (CPK) and liver fractions), radiological examination (chest CT scan), ultrasound examinations (dopplerography of the lower limb vessels and scanning of subcutaneous nodules), histopathology study and intradermal tuberculin skin test.
Results In 40 (3 men, 37 women, mean age 42±15 [24;61]) out of 548 patients the following RDs were verified: Behcet Disease (12), Systemic Lupus Erythematosus (SLE) (10), Rheumatoid Arthritis (5), Sjogren Syndrome and Dermatomyositis(Dm) (4 cases each), Reactive Arthritis(3), Ankylosing Spondylitis and Eosinophilic Fasciitis (1 case each). Two types of Pn were identified: Lobular (LPn) and Septal (SPn). LPn was identified in 8 patients (4 with SLE and 4 with Dm). It was characterized with multiple “saucer-like” moderately painful nodules (VAS intensity of 46±19.3 mm), concentrated on the lower and upper extremities and occasionally on the chest and body, with further development of SF atrophyand high activity (ESR 32.7±12.2 mm/h, Hb 99±10.4 g/%, CK 1100±345 U/l, ds DNA 93.2±21U/ml). The LPn course was more severe and intractable, requiring prescription of glucocorticoids and cytostatic agents in high doses. SPn was more common in RD patients (n=32), and associated with EN with average duration of disease of 12±18 months [1;48] and moderate activity of the inflammatory process. Ultrasound scan and histological examination of the subcutaneous nodules confirmed SPn (with predominant inflammatory changes in septa) or LPn (with inflammatory changes in fat lobules) in RD patients.
Conclusions Clinical and histopathological examination, as well as visual techniques may contribute to early diagnosis of Pn associated with RD.
Disclosure of Interest None declared