Clinical Characteristics of Psoriatic Arthritis in Chinese Patients: A Cross-Sectional Study

Abstract

Introduction:The clinical features of psoriatic arthritis (PsA) varied in different studies from different countries, nevertheless rarely reported from China. We aimed to show the portraits of Chinese PsA patients. Methods: Demographics as well as clinical and laboratory data at the first visit of a PsA cohort were collected. Joints and entheses were further assessed by imaging techniques. The correlation between psoriasis severity index (PASI) and disease activity in PsA (DAPSA) was analyzed. The metabolic comorbidities were also explored among patients with different disease activity. Results: Three hundred patients with definite PsA were enrolled in this study; 159 (53.0%) of them were male. Their median age was 39 (31, 51) years with disease duration of 3 (0.6, 7) years; 15.6% patients were HLA-B27-positive, and 37.8% patients reported a family history of psoriasis or PsA. Among 300 patients, psoriasis presented earlier than arthritis in most of them (214, 74.0%), while 48 (16.6%) patients presented with arthritis before psoriasis. Articular involvement was found in 293 (97.7%) patients.Polyarticular type was most common, with proximal interphalangeal as most frequently involved joints. Axial joint involvement was found in 45 (15.4%) patients. Dactylitis was observed in 94 (31.3%) patients, most often at the second, third, and fourth toes. Enthesitis was found in 18 (6.0%) patients by physical examination, however in 129/227 (56.8%) patients by ultrasound. The DAPSA score was correlated with PASI (r = 0.22, p = 0.021). A variety of comorbidities were more often observed in patients with moderate/high disease activity comparing with those in remission/low-disease activity, especially type 2 diabetes with statistically significant difference (19.1 vs. 4.1%, p = 0.023). However, further logistic regression analysis showed diabetes was not independently associated with moderate/ high disease activity. The most frequently prescribed medication was methotrexate (101, 66.4%). Biological agents were applied in 25 (16.4%) patients. Conclusions: Polyarticular involvement was most common in Chinese PsA patients. Ultrasound dramatically increased the identification of peripheral enthesitis. Active PsA patients were more likely to have comorbidities.

Clinical Characteristics of Patients With Psoriatic Spondylitis Versus Those With Ankylosing Spondylitis: Features at Baseline Before Biologic Therapy

“…The most common manifestation of joint involvement in PsA has been different in various reports. 8 16 17 18 19 20 21 Some studies have indicated that oligoarthritis, occurring in 37–67% of patients with PsA, is the most common arthropathy in PsA. 20 21 However, recent studies have shown that polyarthritis is the most common manifestation.…”

Spectrum of Spondyloarthritis Among Chinese Populations

“…Axial skeleton involvement was found in 15.4% of patients. Dactylitis was observed in 31.3% patients [ 101 ••]. Other studies showed that the prevalence of dactylitis and enthesitis ranged from 15.4 to 71.4% and from 7.8 to 59.1%, respectively [ 102 ].…”

“…A recent Chinese study showed that the most frequently prescribed medication was methotrexate (66.4%). Biological agents were prescribed in 16.4% of patients [ 101 ••]. In Chinese patients with psoriasis and concomitant PsA, secukinumab demonstrated high efficacy outcomes at week 12 which were sustained through week 52 [ 108 •].…”

Neurological Complications of Biological Treatment of Psoriasis

“…This kind of psoriasis concerns 85-90% of cases [3]. Other forms of psoriasis in which dermal changes occur are pustular, inverse, napkin, guttate, oral, and seborrheic-like, which affect approximately 10% of patients [4]. Palmoplantar involvement is usually associated with serious thickening of the skin and, in some rare cases, sterile pustules [5].…”

“…Psoriatic arthritis is an inflammatory condition of the joints which occurs in psoriasis. It affects 7-42% of the patients suffering from psoriasis [4], with 1-2% of patients exhibiting arthritis without the accompanying dermal symptoms [6]. The principal symptoms are inflammation of the spinal joints, neck pain, and inflammatory chest pain, as well as core symptoms [6,7]; 40-60% of the patients develop long-lasting joint complications [8].…”