Lewinson Ryan T, Vallerand Isabelle A, Parsons Laurie M, LaMothe Jeremy M, Frolkis Alexandra D, Lowerison Mark W, Kaplan Gilaad G, Patten Scott B, Barnabe Cheryl
Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada.
RMD Open. 2018 May 21;4(1):e000668. doi: 10.1136/rmdopen-2018-000668. eCollection 2018.
Imaging studies in patients with cutaneous psoriasis have demonstrated asymptomatic bone and tendon changes, commonly of the foot and ankle. We sought to determine if patients with cutaneous psoriasis have an increased risk of clinically significant foot and ankle tendinopathy or enthesopathy compared with the general population.
Patients with cutaneous psoriasis and a general population cohort were identified in The Health Improvement Network, a general practice medical records database from the UK. All patients with psoriatic arthritis were excluded. Cox proportional-hazards models (α=0.05) estimated the HR for development of foot and ankle tendinopathy or enthesopathy among patients with psoriasis, with adjustment for numerous covariates.
In total, 78 630 patients with cutaneous psoriasis and 5 983 338 persons from the general population were identified. In an unadjusted model, patients with cutaneous psoriasis had a 25% increased risk of developing foot and ankle tendinopathy or enthesopathy compared with the general population (HR 1.25, 95% CI 1.20 to 1.30, p<0.0001). The HR remained unchanged and statistically significant after adjusting for covariates, and in sensitivity analyses.
These data suggest that patients with psoriasis can have foot and ankle tendinopathy or enthesopathy without having psoriatic arthritis, presenting a diagnostic challenge to physicians. Further research is needed to elucidate mechanisms contributing to this increased risk.
对皮肤银屑病患者的影像学研究已证实存在无症状的骨骼和肌腱变化，常见于足部和踝关节。我们试图确定与普通人群相比，皮肤银屑病患者发生具有临床意义的足部和踝关节肌腱病或附着点病的风险是否增加。
在英国的一个全科医疗记录数据库“健康改善网络”中识别出皮肤银屑病患者和普通人群队列。所有银屑病关节炎患者均被排除。Cox比例风险模型（α=0.05）估计了银屑病患者发生足部和踝关节肌腱病或附着点病的风险比（HR），并对众多协变量进行了调整。
总共识别出78630例皮肤银屑病患者和5983338名普通人群。在未调整的模型中，与普通人群相比，皮肤银屑病患者发生足部和踝关节肌腱病或附着点病的风险增加25%（HR 1.25，95%CI 1.20至1.30，p<0.0001）。在调整协变量后以及在敏感性分析中，HR保持不变且具有统计学意义。
这些数据表明，银屑病患者可能在没有银屑病关节炎的情况下发生足部和踝关节肌腱病或附着点病，这给医生带来了诊断挑战。需要进一步研究以阐明导致这种风险增加的机制。
