Rheumatic manifestations of psoriasis

Abstract

Psoriatic arthritis was described as a distinct rheumatic disease in the 1960s, and subsequently grouped among the spondyloarthropathies. Recently, other rheumatic manifestations of psoriasis, such as enthesopathy and osteoperiostitis, were recognized. This study attempts to examine the rheumatological and radiological manifestations of Psoriasis and their association with skin and nail disease. Eighty-one psoriatic outpatients were interviewed consecutively during 6 months. Questionnaires and indices were carried out to assess the extent and severity of skin and nail involvement, as well as the activity and severity of peripheral and axial rheumatic manifestations. Radiological examination of the hands, feet, spine and pelvis was also done for all patients. Fifty-nine psoriatic outpatients (73%) had rheumatic manifestations clinically and/or radiologically (Psoriatic arthropathy "PsA"). Clinical peripheral arthritis was found in 14 (23.7%) of the patients with PsA, being oligoarticular in 11, polyarticular in two, and exclusively of the distal interphalangeal (DIP) joints in one patient. Sacroiliitis and/or spondylitis were found in 38 (64.4%), enthesopathy in 36 (61%), dactylitis in two (3.3%), radiological DIP involvement in 24 (40.6%), and radiological osteoperiostitis in 49 (83%) of patients with PsA. Most PsA patients had more than one rheumatic manifestation, while four patients (6.7%) had isolated enthesopathy without any other rheumatic manifestations. Subungual hyperkeratosis of the nails was significantly correlated with PsA (p<0.05), as well as with clinical arthritis, enthesopathy, and DIP involvement (p<0.01), while other types of skin and nail lesions were correlated with selected rheumatic manifestations. The performance of existing criteria for PsA was poor, as individual sets favored either sensitivity or specificity. Psoriatic arthropathy (PsA), occurring in about three-quarters of hospital outpatients with psoriasis, is more common than previously thought. More sensitive and specific criteria for the diagnosis and classification of PsA need to be developed, taking into account the recently described clinical and radiological manifestations.

Detecting Psoriasis Arthritis Early in the Disease Course – Why This is Important and How Dermatologists and Rheumatologists Can Successfully Cooperate?

“…This accounts for 79,6% patients being positive for PsA manifestation. This percentage of PsA among patients with Ps is in line with earlier publications (Sadek, 2007). Furthermore, 23 patients were first diagnosed as having PsA.…”

Clinical features and types of articular involvement in patients with psoriatic arthritis

“…The prevalence of psoriasis in Caucasians might be as high as 1-2 %. While the prevalence of any arthritis in the population is 2-3 %, this increases up to 6-42 % in psoriasis patients [2][3][4][5]. The prevalence of PsA in the general population varies between 0.04 and 0.1 % [6][7][8][9].…”

Sensitivity of the GEPARD Patient Questionnaire to Identify Psoriatic Arthritis in Patients with Psoriasis in Daily Practice: The GEPARD-Life Study

“…The final diagnosis of rheumatologists, however, was lower with 21.1% (104/517). In relation to all exam- In the literature, the worldwide prevalence of PsA in patients with psoriasis varies between 10 and 30% [2][3][4][5] . The rate of 17.5% positive CASPAR-classified PsA in psoriasis patients with 10.4% with active PsA in this study fits this range.…”

“…Following epidemiological studies, the average prevalence of psoriatic arthritis (PsA) among psoriasis patients is 10-30% [2][3][4][5] . In approximately 60% of these, disease manifestation of the skin precedes joint inflammation.…”