Correspondence to Pr Pascal Richett, Fédération de Rhumatologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75475 Paris cedex 10, France.
Ann Rheum Dis. 2013 Apr;72(4):566-71. doi: 10.1136/annrheumdis-2012-201610. Epub 2012 Jun 7.
Psoriasis is an important clinical feature in spondyloarthritis. However, the influence of psoriasis on the clinical, functional and imaging features of patients with inflammatory back pain (IBP) related to spondyloarthritis is not known.
To determine the prevalence of psoriasis and its impact in patients with recent IBP suggestive of spondyloarthritis.
The prevalence of psoriasis was determined in 692 patients (mean age 33.3±8.5 years, 53.8% female, 58.3% human leucocyte antigen B27 positive) included in the DESIR cohort. Demographic characteristics, imaging features and blood tests of patients with and without psoriasis were compared.
The prevalence of psoriasis was 16.6%. Patients with rather than without psoriasis more often presented with enthesitis (59.1% vs 47.5%; p=0.02) and had more active disease (BASDAI 4.8±1.8 vs 4.4±2.0; p=0.05) and poorer functional status (BASFI 3.6±2.2 vs 3.0±2.3; p=0.006; SF-36 (physical function) 61.9±24.4 vs 66.9±24.9; p=0.04). Patients with psoriasis showed higher levels of C-reactive protein (p=0.02), total cholesterol (p=0.01) and triglycerides (p=0.02). The two groups did not differ in structural changes as assessed by standard x-rays or MRI at the spinal and sacroiliac levels. However, ultrasonography of the Achilles tendon revealed psoriasis associated with bone erosions (p=0.0003) and abnormal vascularisation (p=0.04). Multivariate regression analysis revealed BASFI score (p=0.03), cholesterol level (p=0.02), dactylitis (p=0.0006) and family history of psoriasis (p<0.0001) as independent predictors of psoriasis.
In patients with recent IBP suggestive of spondyloarthritis, psoriasis is associated with active axial disease and frequent concomitant enthesopathy and dactylitis.
银屑病是脊柱关节炎的一个重要临床特征。然而，银屑病对炎症性背痛（IBP）相关脊柱关节炎患者的临床、功能和影像学特征的影响尚不清楚。
确定新近出现 IBP 且提示脊柱关节炎的患者中银屑病的患病率及其影响。
在 DESIR 队列中纳入 692 例（平均年龄 33.3±8.5 岁，53.8%为女性，58.3%人类白细胞抗原 B27 阳性）患者，确定银屑病的患病率。比较有和无银屑病患者的人口统计学特征、影像学特征和血液检查结果。
银屑病的患病率为 16.6%。有银屑病的患者比无银屑病的患者更常出现附着点炎（59.1% vs 47.5%；p=0.02），且疾病更活跃（BASDAI 4.8±1.8 vs 4.4±2.0；p=0.05），功能状态更差（BASFI 3.6±2.2 vs 3.0±2.3；p=0.006；SF-36 生理功能评分 61.9±24.4 vs 66.9±24.9；p=0.04）。银屑病患者的 C 反应蛋白（p=0.02）、总胆固醇（p=0.01）和甘油三酯（p=0.02）水平更高。两组在脊柱和骶髂关节水平的标准 X 线或 MRI 评估的结构变化方面无差异。然而，跟腱的超声检查显示，银屑病与骨侵蚀（p=0.0003）和异常血管化（p=0.04）有关。多变量回归分析显示，BASFI 评分（p=0.03）、胆固醇水平（p=0.02）、指炎（p=0.0006）和银屑病家族史（p<0.0001）是银屑病的独立预测因素。
在新近出现 IBP 且提示脊柱关节炎的患者中，银屑病与活动性轴性疾病以及频繁伴发的附着点病和指炎有关。
