Home›Rheumatology› Adalimumab improves axial inflammation in hidradenitis suppurativa with spondyloarthritis features
Adalimumab improves axial inflammation in hidradenitis suppurativa with spondyloarthritis featuresAdalimumab Treatment Improves Skin and Joint Issues for One Patient
Frontiers in MedicinePublished August 19, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider sacroiliac MRI after rheumatologic assessment in hidradenitis suppurativa with enthesitis-like symptoms.
This is a case report of a 31-year-old man with Hurley stage II hidradenitis suppurativa who also had features of spondyloarthritis, including calcaneal tenderness and evidence of axial inflammation. The patient was treated with adalimumab at the licensed hidradenitis suppurativa regimen. At 6 months, clinical and imaging responses were observed: calcaneal tenderness and skin lesions improved, inflammatory markers normalized, and follow-up MRI showed substantial reduction in bone marrow edema.
The case highlights that axial inflammation in hidradenitis suppurativa may be under-recognized when assessment relies exclusively on patient-reported back pain. The authors suggest that MRI of sacroiliac joints may be considered after rheumatologic assessment when multiple features raise suspicion of spondyloarthritis. However, they caution that sacroiliac MRI should not be used routinely in all patients with hidradenitis suppurativa and enthesitis-like symptoms.
Limitations include the small sample size inherent to a case report. No adverse events, discontinuations, or tolerability data were reported. The primary outcome was not specified, and no effect sizes or confidence intervals were provided.
For clinicians, this case suggests that in patients with hidradenitis suppurativa who present with enthesitis-like symptoms, a rheumatologic evaluation and targeted imaging may uncover axial inflammation that could respond to TNF inhibition. However, given the evidence level, these findings should be interpreted with caution and not generalized to all patients.
How this fits prior evidence
This case report extends prior coverage by illustrating that adalimumab, already noted for its efficacy in ankylosing spondylitis and juvenile idiopathic arthritis, may also address axial inflammation in hidradenitis suppurativa. It aligns with the prior finding that adalimumab shows distinct response clusters in ankylosing spondylitis, suggesting a potential shared mechanism. However, this is a single case, so it does not confirm broader efficacy. It also underscores the need to consider axial involvement in hidradenitis suppurativa, complementing earlier reports on the psychological burden of chronic skin conditions.
A medical report describes the experience of a 31-year-old man living with hidradenitis suppurativa, a chronic skin condition. During his treatment with adalimumab, doctors observed improvements in both his skin lesions and his joint pain. Specifically, he experienced less tenderness in his heels and showed improved results on follow-up MRI scans.
The study highlights that patients with certain skin conditions may also have underlying issues with their joints and bones. In this case, the patient's inflammatory markers returned to normal levels after six months of treatment. This suggests that some people with skin issues might also experience inflammation in areas like the sacroiliac joints.
Because this was a report on only one person, the results are not enough to make broad claims for everyone. The findings suggest that doctors should look closely at joint health when treating certain skin conditions. Patients should talk to their healthcare team to determine if specific imaging or extra tests are necessary based on their individual symptoms.
What this means for you:
One case shows adalimumab improved both skin lesions and joint inflammation in a patient with hidradenitis suppurativa.
Common questions
What did the study find about skin and joint pain?
The case report followed one 31-year-old man for six months. He showed improvement in his skin lesions and experienced less tenderness in his heels. His inflammatory markers normalized, and follow-up MRI scans showed a substantial reduction in bone marrow edema.
Is this treatment safe for everyone with these conditions?
This was a report on only one patient, so the results cannot be applied to everyone. The study did not report any specific adverse events or safety concerns during the six-month follow-up period. You should talk to your doctor about your specific health needs.
Why is this finding important for patients with hidradenitis suppurativa?
The report suggests that some people with skin issues may also have underlying joint inflammation. It highlights that doctors should consider checking for joint involvement, such as in the sacroiliac joints, when a patient reports symptoms like heel pain or other signs of spondyloarthritis.
Hidradenitis suppurativa is increasingly recognized as a systemic inflammatory disease with an established overlap with spondyloarthritis. Axial spondyloarthritis is usually suspected when patients report inflammatory back pain, which remains the entry feature of the ASAS axial spondyloarthritis classification criteria. We report a 31-year-old man with Hurley stage II hidradenitis suppurativa who presented with Achilles enthesitis supported by point-of-care ultrasound but denied any current or previous back pain lasting 3 months or longer, including inflammatory back pain and alternating buttock pain, prolonged morning stiffness, peripheral arthritis, dactylitis, uveitis, psoriasis, and gastrointestinal symptoms. During workup for asymptomatic microscopic hematuria, computed tomography of the pelvis incidentally showed bilateral sacroiliac joint abnormalities that prompted dedicated imaging. Magnetic resonance imaging of the sacroiliac joints showed findings meeting the consensus definition of active sacroiliitis, with bilateral subchondral bone marrow edema and early structural changes. The patient was human leukocyte antigen B27 positive, had elevated inflammatory markers, and had a first-degree family history of ankylosing spondylitis. Although the ASAS axial spondyloarthritis classification criteria were not fulfilled because the required history of back pain lasting 3 months or longer was absent, the patient fulfilled the ASAS peripheral spondyloarthritis classification criteria based on current Achilles enthesitis together with HLA-B27 positivity and sacroiliitis on imaging. Converging clinical, imaging, immunogenetic, and familial features supported a clinical diagnosis of spondyloarthritis associated with hidradenitis suppurativa. Adalimumab was started using the licensed hidradenitis suppurativa regimen. At 6 months, calcaneal tenderness and skin lesions had improved, inflammatory markers had normalized, and follow-up imaging showed substantial reduction in bone marrow edema. This case suggests that axial inflammation in hidradenitis suppurativa may be under-recognized when assessment relies exclusively on patient-reported back pain. Sacroiliac MRI should not be used routinely in all patients with hidradenitis suppurativa and enthesitis-like symptoms but may be considered after rheumatologic assessment when multiple clinical, laboratory, familial, or incidental imaging features collectively raise suspicion of spondyloarthritis.
