HS linked to diverse arthritis patterns and metabolic burden, with IL-17 inhibitors showing promise

Hidradenitis suppurativa (HS) is increasingly recognized as a systemic inflammatory condition with manifestations beyond the skin. A recent retrospective pilot study evaluated patterns of musculoskeletal (MSK) involvement in patients with HS, highlighting variability in clinical presentation, a high burden of metabolic comorbidities, and potential benefits of biologic therapy.^1,2

The investigators conducted a descriptive observational study of 8 patients with HS and concurrent MSK symptoms treated at a single center between May 2022 and April 2024. The study aimed “to characterize patterns of musculoskeletal (MSK) involvement in HS patients, assess disease severity and related metabolic comorbidities, and determine the impact of biologic therapy on symptom control.”

Patterns of musculoskeletal involvement

Among the cohort, MSK manifestations were heterogeneous. Peripheral arthritis was the most common presentation, observed in 62.5% of patients, followed by mixed axial and peripheral disease (25%) and isolated axial involvement (12.5%).

Peripheral arthritis most frequently involved the shoulders, wrists, knees, and ankles and was often associated with intermittent swelling and tenderness. Axial disease presented as sacroiliitis in affected patients.

Enthesitis emerged as a prominent feature, affecting 75% of the cohort. The Achilles tendon and plantar fascia were the most commonly involved sites. As noted in the study, “Enthesitis emerged as a prominent clinical feature, affecting 75% of our patients, most frequently affecting the Achilles tendon and plantar fascia.”

Despite all patients being classified as Hurley stage II or III, no clear association was identified between cutaneous disease severity and the pattern of MSK involvement.

High burden of metabolic comorbidities

Metabolic abnormalities were highly prevalent in this cohort. Obesity was present in 62.5% of patients, while 75% had evidence of hepatic steatosis and elevated glycated hemoglobin levels.

The authors reported, “Metabolic dysfunction was also highly prevalent, including obesity in 62.5% of patients, fatty liver disease in 75%, and elevated HbA_1c levels in 75%.”

Additional comorbidities included hypercholesterolemia, hyperuricemia, and psoriasis. These findings align with prior evidence linking HS to metabolic syndrome and systemic inflammation.

The study further contextualized these findings with emerging data suggesting that metabolic syndrome may increase the risk of developing HS, emphasizing the importance of screening and management of metabolic risk factors in this population.

Treatment response and role of biologics

Treatment responses varied by therapy class. Nonsteroidal anti-inflammatory drugs provided short-term symptomatic relief but were generally insufficient for long-term disease control.

Biologic therapies demonstrated more robust clinical benefits. In particular, interleukin-17 (IL-17) inhibition was associated with improved outcomes in both MSK and cutaneous disease. The authors noted, “In contrast, biologic therapies, particularly IL-17 inhibitor (secukinumab), demonstrated greater efficacy in controlling both MSK and cutaneous manifestations.”

Patients who transitioned from tumor necrosis factor (TNF) inhibitors to IL-17 inhibitors reported improved symptom control, suggesting a potential therapeutic advantage in select patients.

Clinical implications

The findings reinforce that HS is not limited to cutaneous involvement but may present with systemic inflammatory manifestations, including arthritis and enthesitis. The study states, “HS-associated MSK involvement manifests in diverse clinical patterns and is often associated with metabolic comorbidities.”

These observations underscore the importance of multidisciplinary care, particularly collaboration between dermatology and rheumatology, to ensure early recognition and management of MSK symptoms.

Routine screening for joint symptoms and metabolic abnormalities may help identify patients at risk for disease progression and guide treatment decisions.

Limitations and future directions

The authors acknowledge several limitations, including the small sample size, retrospective design, and lack of standardized diagnostic and imaging criteria.

Further research is needed to better define the prevalence, timing, and clinical spectrum of MSK involvement in HS, as well as to establish optimal treatment strategies.

The study concludes, “However, larger-scale screening and long-term prospective studies are required to better characterize MSK prevalence, onset, clinical patterns, and relationship with cutaneous disease severity and activity, as well as to establish optimal management strategies for HS and HS-associated arthritis.”

References

1. Suliman Y, Attia E. Patterns of musculoskeletal involvement in hidradenitis suppurativa: a pilot study. Cureus. Published online April 13, 2026. doi:https://doi.org/10.7759/cureus.106996
2. Saito-Sasaki N, Sawada Y. The development of systemic inflammatory diseases in hidradenitis suppurativa. Diagnostics (Basel). 2023;13(3):502. doi:10.3390/diagnostics13030502