From the Department of Medical and Biological Sciences, Rheumatology Clinic, and the Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy.
A. Zabotti, MD, Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine; E. Errichetti, MD, Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine; F. Zuliani, MD, Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine; L. Quartuccio, MD, PhD, Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine; S. Sacco, MD, Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine; G. Stinco, MD, Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine; S. De Vita, MD, Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine. Alen Zabotti and Enzo Errichetti contributed equally to this work.
J Rheumatol. 2018 May;45(5):648-654. doi: 10.3899/jrheum.170962. Epub 2018 Feb 15.
Exclusion of psoriatic skin/nail lesions is important in differentiating early seronegative rheumatoid arthritis (ERA) from early polyarticular psoriatic arthritis (EPsA) and such manifestations may go unnoticed in atypical or minimally expressed cases. The aim of this study is to assess the usefulness of integrated rheumatological-dermatological evaluation in highlighting dermatological lesions missed on rheumatological examination and to investigate the role of ultrasonography (US) and dermoscopy in improving the recognition of subclinical psoriatic findings.
Patients with a new diagnosis of seropositive or seronegative ERA and EPsA with prevalent hands involvement were recruited. All were reassessed for the presence of psoriatic lesions during an integrated rheumatological-dermatological clinical evaluation and underwent hands US and proximal nailfold dermoscopy.
Seventy-three consecutive subjects were included in the study: 25 with seropositive ERA, 23 with seronegative ERA, and 25 with EPsA. One-fourth of the subjects initially diagnosed as seronegative ERA presented cutaneous or nail psoriasis on integrated rheumatological-dermatological evaluation, thereby being reclassified as EPsA. The presence of at least 1 extrasynovial feature on hand US and dotted vessels on proximal nailfold dermoscopy was significantly associated with EPsA, with a sensitivity of 68.0% and 96.0% and a specificity of 88.1% and 83.3% for US and dermoscopy, respectively. When used together, specificity for PsA diagnosis raised to 90.5%.
Integrated rheumatological-dermatological clinical evaluation may be helpful in identifying patients with EPsA misclassified as seronegative ERA. Additionally, US and dermoscopy may be used as supportive tools in identifying subclinical psoriatic features, which may come in handy in distinguishing EPsA from ERA.
排除银屑病皮肤/指甲病变对于区分早期血清阴性类风湿关节炎（ERA）和早期多关节银屑病关节炎（EPsA）非常重要，而这些表现可能在不典型或轻度表达的病例中被忽视。本研究旨在评估综合风湿科-皮肤科评估在突出风湿科检查遗漏的皮肤科病变方面的有用性，并研究超声（US）和皮肤镜在提高亚临床银屑病发现的识别能力方面的作用。
招募了新诊断为血清阳性或血清阴性 ERA 和 EPsA 且手部受累为主的患者。所有患者均在综合风湿科-皮肤科临床评估期间重新评估是否存在银屑病病变，并进行手部 US 和近端甲襞皮肤镜检查。
共有 73 例连续患者纳入研究：25 例为血清阳性 ERA，23 例为血清阴性 ERA，25 例为 EPsA。四分之一最初诊断为血清阴性 ERA 的患者在手部综合风湿科-皮肤科评估中出现皮肤或指甲银屑病，从而被重新分类为 EPsA。手部 US 上存在至少 1 个关节外特征和近端甲襞皮肤镜上的点状血管与 EPsA 显著相关，其敏感性分别为 68.0%和 96.0%，特异性分别为 88.1%和 83.3%。当两者联合使用时，对 PsA 的诊断特异性提高至 90.5%。
综合风湿科-皮肤科临床评估有助于识别被误诊为血清阴性 ERA 的 EPsA 患者。此外，US 和皮肤镜可作为识别亚临床银屑病特征的辅助工具，有助于将 EPsA 与 ERA 区分开来。
