Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
J Dermatol. 2017 Dec;44(12):1349-1352. doi: 10.1111/1346-8138.13968. Epub 2017 Jul 10.
Psoriatic arthritis (PsA) is a spondyloarthritic condition mainly seen in patients with psoriasis. Psoriatic patients with plaques on the scalp, gluteal fold or nail lesions are known to develop PsA more frequently, but other markers for PsA have not yet been identified. To determine which psoriatic patients are at greatest risk of developing PsA, psoriasis vulgaris (PsV) patients who visited the Department of Dermatology, Fukuoka University Hospital in 2015 were enrolled. Patients with and without PsA were statistically compared with respect to age, sex, age at onset, body mass index (BMI), smoking and drinking habits, familial history of psoriasis and comorbidities. Of 331 patients (237 men, 94 women), 55 had PsA (17%; 39 men, 16 women). PsA patients had significantly higher frequencies of nail lesions (PsA vs PsV-only, 62% vs 29%; P < 0.0001) and hyperuricemia (PsA vs PsV-only, 22% vs 9%; P = 0.01). These were confirmed as independent risk factors for PsA by logistic regression analysis, with odds ratios of 5.05 for nail lesions (P < 0.0001) and 4.18 for hyperuricemia (P < 0.01). There was no difference in age at onset, sex, BMI and incidence of diabetes mellitus, hypertension or dyslipidemia. Hyperuricemia is also known to be more frequent in psoriatic subjects than the normal population. Uric acid crystals are a strong stimulator of innate immunity. Considering that none of our cohort had gouty arthritis, hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects. Hyperuricemia appears to be an independent risk factor for PsA.
银屑病关节炎（PsA）是一种主要发生在银屑病患者中的脊柱关节病。已知头皮、臀褶或指甲病变的银屑病患者更常发生 PsA，但尚未确定其他 PsA 标志物。为了确定哪些银屑病患者患 PsA 的风险最大，我们招募了 2015 年在福冈大学医院皮肤科就诊的寻常型银屑病患者。统计比较了有和无 PsA 的患者的年龄、性别、发病年龄、体重指数（BMI）、吸烟和饮酒习惯、银屑病家族史和合并症。在 331 例患者（237 例男性，94 例女性）中，有 55 例患有 PsA（17%；39 例男性，16 例女性）。PsA 患者指甲病变（PsA 与单纯 PsV，62%与 29%；P<0.0001）和高尿酸血症（PsA 与单纯 PsV，22%与 9%；P=0.01）的频率显著更高。通过逻辑回归分析，指甲病变（OR=5.05，P<0.0001）和高尿酸血症（OR=4.18，P<0.01）被确认为 PsA 的独立危险因素。发病年龄、性别、BMI 以及糖尿病、高血压或血脂异常的发生率无差异。已知银屑病患者的高尿酸血症比正常人群更常见。尿酸晶体是先天免疫的强刺激物。考虑到我们的队列中没有痛风性关节炎，高尿酸血症可能会增加关节内和周围的尿酸结晶，从而在银屑病患者中诱导 PsA。高尿酸血症似乎是 PsA 的一个独立危险因素。
