Novel association of chilblains with inflammatory arthritis- series of three cases and review of literature.

Chilblains are well circumscribed erythrocyanotic lesions seen usually on limbs distally and triggered by cold and damp conditions; they can be primary or secondary. Association of SLE and chilblains is well established, and there are also reports of associations with vasculitis and antiphospholipid syndrome. There remain considerable gaps in literature about the management of secondary chilblains. Three studies looking at primary chilblains showed some benefit from corticosteroids, but this was inferior to pentoxifylline and tadalafil. There are no trials in secondary chilblains. Chilblains have not been described in the context of inflammatory arthritis- either Rheumatoid Arthritis or seronegative spondyloarthropathy. We report 3 patients with a combination of chilblains, seronegative inflammatory arthritis and phalangeal bone marrow oedema on MRI scans. These patients presented with joint symptoms alongside chilblains with conclusive evidence of inflammatory arthritis. Immunosuppressive treatment resulted in an excellent clinical response. Literature review did not identify any previous descriptions of chilblains together with inflammatory arthritis, whilst bone marrow oedema has primarily been described in children together with chilblains. This case series provides some support for managing secondary chilblains through immunosuppression such as corticosteroids and disease modifying drugs.