Yan Di, Ahn Richard, Leslie Stephen, Liao Wilson
Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
Department of Microbiology, Immunology and Molecular Genetics, Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, CA, USA.
Dermatol Ther (Heidelb). 2018 Dec;8(4):593-604. doi: 10.1007/s13555-018-0266-x. Epub 2018 Oct 20.
Psoriatic arthritis (PsA) is a chronic, inflammatory arthritis that affects an estimated 30% of patients with psoriasis. PsA is underdiagnosed in primary care and dermatology clinics due to a variety of reasons, including failure of healthcare providers to ask about symptoms, overlap of symptoms and signs with other rheumatologic conditions, and lack of a specific diagnostic test. A delay in PsA diagnosis and treatment, even as short as 6 months, can lead to decreased quality of life, increased joint damage, and worse long-term physical function. In this study, we sought to identify the clinical and genetic factors that help discriminate patients with PsA from those with cutaneous psoriasis only.
We analyzed a cohort of 974 psoriasis patients at an academic medical center, of whom 175 had confirmed PsA, and performed univariate, multivariate, and predictive modeling to determine factors associated with PsA.
The univariate analysis revealed significant positive associations of PsA with age, nail involvement, scalp involvement, skin fold involvement, elbow/knee involvement, psoriasis severity, plaque subtype, erythrodermic subtype, hypertension, type 2 diabetes, and coronary artery disease, and a significant negative association of PsA with the human leukocyte antigen (HLA)-C06:02 allele. In the multivariate analysis, nail involvement, type 2 diabetes, and pustular psoriasis remained significantly associated with PsA, while HLA-C06:02 positivity remained protective. There was a trend towards an association of PsA with older age, younger age of psoriasis onset, and skin fold involvement, while there was protective trend for smoking. A predictive model including both clinical and genetic factors showed reasonable discriminative ability between psoriasis and PsA, with an area under the curve of 0.87 for a receiver operating characteristic curve.
This study identified a number of clinical and genetic features that could help stratify patients who are at higher risk for having PsA and for whom rheumatology referral may be beneficial.
银屑病关节炎（PsA）是一种慢性炎症性关节炎，估计影响30%的银屑病患者。由于多种原因，包括医疗服务提供者未询问症状、症状和体征与其他风湿性疾病重叠以及缺乏特异性诊断测试，PsA在初级保健和皮肤科诊所中未得到充分诊断。PsA诊断和治疗的延迟，即使短至6个月，也会导致生活质量下降、关节损伤增加以及长期身体功能恶化。在本研究中，我们试图确定有助于将PsA患者与仅患有皮肤银屑病的患者区分开来的临床和遗传因素。
我们分析了一家学术医疗中心的974例银屑病患者队列，其中175例确诊为PsA，并进行了单变量、多变量和预测模型分析，以确定与PsA相关的因素。
单变量分析显示，PsA与年龄、指甲受累、头皮受累、皮肤褶皱受累、肘/膝受累、银屑病严重程度、斑块亚型、红皮病亚型、高血压、2型糖尿病和冠状动脉疾病呈显著正相关，与人类白细胞抗原（HLA）-C06:02等位基因呈显著负相关。在多变量分析中，指甲受累、2型糖尿病和脓疱型银屑病仍与PsA显著相关，而HLA-C06:02阳性仍具有保护作用。PsA与年龄较大、银屑病发病年龄较小和皮肤褶皱受累之间存在关联趋势，而吸烟则有保护趋势。一个包括临床和遗传因素的预测模型在银屑病和PsA之间显示出合理的鉴别能力，受试者操作特征曲线的曲线下面积为0.87。
本研究确定了一些临床和遗传特征，这些特征有助于对患PsA风险较高且转诊至风湿病科可能有益的患者进行分层。
