From the Guidelines
Rheumatoid arthritis can potentially exacerbate Sweet syndrome due to shared inflammatory pathways and cytokine dysregulation. Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a condition characterized by painful red plaques or nodules on the skin, fever, and general malaise. The connection between rheumatoid arthritis and Sweet syndrome involves inflammatory processes, particularly involving interleukin-1 and tumor necrosis factor-alpha 1.
Key Considerations
- Rheumatoid arthritis flares can trigger or worsen Sweet syndrome symptoms
- Management requires treating both conditions simultaneously
- Medications like corticosteroids, colchicine, or dapsone may be used for Sweet syndrome, while continuing rheumatoid arthritis treatments such as methotrexate, hydroxychloroquine, or biological agents
- Patients should monitor for skin changes during rheumatoid flares and maintain regular follow-ups with both rheumatology and dermatology specialists to adjust treatment plans accordingly
Treatment Approach
- The European League Against Rheumatism (EULAR) recommends methotrexate (rapid escalation to 25 mg/week) plus short-term glucocorticoids as the first strategy for managing rheumatoid arthritis 1
- In cases where rheumatoid arthritis is complicated by Sweet syndrome, treatment plans may need to be adjusted to address both conditions simultaneously
- Regular monitoring and follow-ups with specialists are crucial to manage the conditions effectively and prevent exacerbations.
From the Research
Association between Rheumatoid Arthritis and Sweet Syndrome
- There are several case reports indicating an association between Sweet's syndrome and rheumatoid arthritis (RA) 2, 3.
- Proinflammatory cytokines are considered to play a vital role in the pathogenesis of both RA and Sweet's syndrome 2.
- The concurrent or sequential development of Sweet's syndrome and other neutrophilic dermatoses, such as pyoderma gangrenosum, has been observed in patients with RA 4.
Exacerbation of Sweet Syndrome by Rheumatoid Arthritis
- There is evidence to suggest that RA can exacerbate Sweet's syndrome, as seen in a case report of a patient with seropositive RA who developed Sweet's syndrome after starting adalimumab therapy 2.
- However, it is unclear whether the development of Sweet's syndrome in this patient was related to the RA or the paradoxical effect of adalimumab 2.
- Another case report describes a patient with RA, Sjögren's syndrome, and lymph node tuberculosis who developed Sweet's syndrome, highlighting the complexity of associations between these conditions 3.
Treatment of Sweet Syndrome in Patients with Rheumatoid Arthritis
- Systemic corticosteroids are considered the mainstay of treatment for Sweet's syndrome, but alternative therapies such as colchicine, dapsone, and potassium iodide may also be effective 5, 4, 6.
- Tumor necrosis factor-alpha antagonists, such as adalimumab, may be used to treat Sweet's syndrome in patients with RA, but their use can also be associated with paradoxical development of Sweet's syndrome 2, 4.