银屑病是轴性脊柱关节炎肌腱端损伤的独立危险因素。

Psoriasis is an independent risk factor for entheseal damage in axial spondyloarthritis.

机构信息

University of Ottawa Faculty of Medicine, Rheumatology, Ottawa, ON, Canada.

出版信息

Semin Arthritis Rheum. 2020 Feb;50(1):42-47. doi: 10.1016/j.semarthrit.2019.06.016. Epub 2019 Jun 28.

DOI:10.1016/j.semarthrit.2019.06.016

PMID:31324469

Abstract

OBJECTIVES

To understand whether psoriasis has disease modifying effects on disease features and/or severity of enthesitis and spine disease in axial SpA (axSpA).

METHODS

Patients with a diagnosis axSpA were included. Demographics, patient and physician reported outcomes were collected. Radiographic damage in the spine was assessed using modified Ankylosing Spondylitis Spine Score (mSASSS). Twelve entheses of the upper and lower extremity were assessed using ultrasound, focusing on inflammation and damage separately. The association between mSASSS, enthesitis scores and extra-articular manifestations such as psoriasis was analyzed using linear regression analysis.

RESULTS

Among 120 axSpA patients 114 (95%) had axSpA according to The Assessment of SpondyloArthritis international Society (ASAS) criteria. Sixty-two were classified as ankylosing spondylitis (AS), fulfilling the modified New York criteria. Thirty-one patients had psoriasis. For spinal damage, entheseal damage was an independent and the strongest predictor (B = 0.52, p = 0.025), in addition to longer disease duration (B = 0.22, p = 0.045) and male gender (B = 6.1, p = 0.041) but not psoriasis. For enthesitis, psoriasis was found as an independent risk factor to increase the entheseal damage (B = 4.38, p = 0.009), in addition to age (B = 0.17, p = 0.007), male gender (B = 2.8, p = 0.032), mSASSS (B = 0.11, p = 0.035) and body mass index (B = 0.57, p < 0.001), but not entheseal inflammation (B = 2.0, p > 0.05) when corrected for HLA-B27.

CONCLUSIONS

Psoriasis is an independent risk factor to increase the severity of entheseal damage, but not spinal damage. Peripheral enthesitis predicts spinal damage, regardless of the subtypes of SpA.

摘要

目的

了解银屑病是否对中轴型脊柱关节炎（axSpA）的疾病特征和/或肌腱附着点炎和脊柱疾病的严重程度有疾病修饰作用。

方法

纳入 axSpA 诊断患者。收集人口统计学、患者和医生报告的结果。使用改良强直性脊柱炎脊柱评分（mSASSS）评估脊柱的放射学损伤。使用超声评估上肢和下肢的 12 个肌腱附着点，分别评估炎症和损伤。使用线性回归分析分析 mSASSS、肌腱附着点评分与关节外表现（如银屑病）之间的关系。

结果

在 120 例 axSpA 患者中，根据脊柱关节炎评估协会（ASAS）标准，114 例（95%）符合 axSpA 诊断。62 例符合改良纽约标准的强直性脊柱炎（AS）。31 例患者患有银屑病。对于脊柱损伤，肌腱附着点损伤是独立的最强预测因素（B=0.52，p=0.025），此外还有更长的疾病持续时间（B=0.22，p=0.045）和男性性别（B=6.1，p=0.041），但与银屑病无关。对于肌腱附着点炎，银屑病被认为是增加肌腱附着点损伤的独立危险因素（B=4.38，p=0.009），此外还有年龄（B=0.17，p=0.007）、男性性别（B=2.8，p=0.032）、mSASSS（B=0.11，p=0.035）和体重指数（B=0.57，p<0.001），但纠正 HLA-B27 后肌腱附着点炎症无相关性（B=2.0，p>0.05）。