Musculoskeletal manifestations with panniculitis - a hospital based study on 62 patients in Kuwait

The study describes 62 patients seen over a period of 4 years mainly presen ting with an acute inflammatory ankle arthritis/periarthritis associated wi th panniculitis. Based upon the clinical characteristics of panniculitis tw o distinct categories could be defined. These included patients with charac teristic lesions of erythema nodosum, seen in 51 (82%), the idiopathic form in 29 (57%), and secondary EN in 22 (43%). Associated conditions included Behcet's disease, oral contraceptive pills, pregnancy and penicillin treatm ent. Patients clinically not having typical EN was seen in 11 (18%). In thi s group the histopathology showed erythema induratum in 4, cutaneous-polyar teritis nodosa with minimal panniculitis in 3, Weber-Christian disease, cyt ophagic histiocytic panniculitis, and 'mixed' lobular and septal variety of panniculitis in 1 each. (In 1 patient the disease was not panniculitis but cutaneous variant of granuloma annulare). It is concluded that in a hospit al setting EN associated with acute musculoskeletal symptoms, mainly ankle arthritis/periarthritis or an acute peripheral polyarthritis, was a common rheumatological problem in Kuwait. However, other forms of panniculitides a lso presented with musculoskeletal manifestations requiring accurate histop athological diagnosis for appropriate treatment.