Swedish Rheumatology Research Group, Swedish Medical Center and University of Washington, Seattle, Washington, USA.
Corrona, Waltham, Massachusetts, USA.
RMD Open. 2019 May 24;5(1):e000867. doi: 10.1136/rmdopen-2018-000867. eCollection 2019.
To compare the characteristics of patients with psoriatic arthritis among patient groups stratified by degree of skin and joint involvement, and to evaluate the relationship between skin severity and joint activity.
Body surface area (BSA) and Clinical Disease Activity Index (CDAI) at enrolment were analysed. Patient characteristics were stratified by skin severity and joint activity. Baseline patient characteristics, clinical and disease characteristics and patient-reported outcomes were compared. The strength of the relationship of skin severity and joint activity was evaluated using methods for categorical variables (χ test, Cramer's V) and continuous variables (linear regression).
1542 adult patients in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry enrolled between 21 May 2013 and 20 September 2016 were analysed. Most patients in the BSA >3%/CDAI moderate/high subgroup had worse clinical and patient-reported outcomes. A significant (p<0.001) modest association (Cramer's V=0.1639) between skin severity and joint activity was observed among all patients at enrolment. Patients with higher skin severity were two times more likely to have higher joint involvement (OR 2.27, 95% CI 1.71 to 3.01). A significant linear relationship between CDAI and BSA was observed. Effect modification showed this linear relationship was modified by age, gender, insurance, work status, current therapy, Health Assessment Questionnaire, Nail visual analogue scale, minimal disease activity, dactylitis count, patient-reported pain and fatigue.
Skin severity is modestly correlated with joint activity, and patients with higher skin severity are two times more likely to have increased joint involvement. Clinicians need to address both skin severity and joint activity in treatment decisions.
比较按皮肤和关节受累程度分层的银屑病关节炎患者群体的特征，并评估皮肤严重程度与关节活动之间的关系。
分析入组时的体表面积（BSA）和临床疾病活动指数（CDAI）。根据皮肤严重程度和关节活动对患者特征进行分层。比较基线患者特征、临床和疾病特征以及患者报告的结局。使用分类变量（卡方检验、Cramer's V）和连续变量（线性回归）评估皮肤严重程度和关节活动之间关系的强度。
对 2013 年 5 月 21 日至 2016 年 9 月 20 日期间入组的 Corrona 银屑病关节炎/脊柱关节炎登记处的 1542 例成年患者进行了分析。BSA＞3%/CDAI 中度/高度亚组的大多数患者具有更差的临床和患者报告结局。在所有入组患者中，皮肤严重程度与关节活动之间存在显著（p＜0.001）适度关联（Cramer's V=0.1639）。皮肤严重程度较高的患者发生更高关节受累的可能性是两倍（OR 2.27，95%CI 1.71 至 3.01）。CDAI 与 BSA 之间存在显著的线性关系。效应修饰表明，这种线性关系受年龄、性别、保险、工作状态、当前治疗、健康评估问卷、指甲视觉模拟量表、最小疾病活动、指炎计数、患者报告的疼痛和疲劳的影响。
皮肤严重程度与关节活动呈中度相关，皮肤严重程度较高的患者发生更高关节受累的可能性是两倍。临床医生在治疗决策中需要同时考虑皮肤严重程度和关节活动。
