Damiani Giovanni, Pacifico Alessia, Rizzi Maurizio, Santus Pierachille, Bridgewood Charlie, Bragazzi Nicola Luigi, Adawi Mohammed, Watad Abdulla
Clinical Dermatology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Clin Rheumatol. 2020 Oct;39(10):2981-2988. doi: 10.1007/s10067-020-05050-2. Epub 2020 Apr 2.
Psoriatic arthritis (PsA) patients are often affected by numerous comorbidities. However, contrasting results have been reported with regard to the respiratory involvement in PsA patients. The aim of this study was to evaluate the presence of subclinical airway inflammation in non-smoking PsA patients compared to patients with only psoriasis using the fraction of exhaled nitric oxide (FeNO) as an indirect marker of airway inflammation.
The study included 164 non-smoking psoriatic patients (Psoriasis Area of Severity Index or PASI score > 10): 82 with and 82 without PsA, who underwent FeNO tests at different flow rates (30, 50, 100, 200 mL/s). PsA patients were evaluated with Disease Activity in PSoriatic Arthritis Score (DAPSA). Both study groups were compared in terms of FeNO values and its association with the PASI score. The correlations between the variables were evaluated by means of Pearson's coefficient.
Patient with PsA had higher levels of FeNO than those with psoriasis but without arthritis (at 30 mL/s, 71.09 ± 18.40 ppb vs 66.88 ± 19.12 ppb (NS); at 50 mL/s, 36.61 ± 9.30 ppb vs 30.88 ± 9.73 ppb (p < 0.001); at 100 mL/s, 19.09 ± 4.66 ppb vs 16.63 ± 4.90 ppb (p < 0.001); and at 200 mL/s, 10.88 ± 2.53 ppb vs 9.43 ± 2.55 ppb (p < 0.001), respectively). PASI score correlated to FeNO only in psoriatic patients without arthritis. However, CASPAR index correlated with FeNO (FeNO30: r = 0.81, p < 0.001; FeNO50: r = 0.84, p < 0.001; FeNO100: r = 0.71, p < 0.001; FeNO200: r = 0.58, p < 0.001). DAPSA was also correlated with FeNO to all flows (FeNO30: r = 0.43, p < 0.001; FeNO50: r = 0.33, p < 0.001; FeNO100: r = 0.34, p < 0.001; FeNO200: r = 0.25, p < 0.001).
PsA patients seem to have more commonly subclinical airway inflammation than those with only psoriasis. Further studies are needed to replicate these findings. Key Points • Fraction of exhaled nitric oxide (FeNO) is a useful device to detect and monitor airway inflammation not only in asthma but also in systemic inflammatory diseases such as psoriatic arthritis and psoriasis. • Clinicians should be aware to check respiratory diseases in patients with psoriatic arthritis.
银屑病关节炎（PsA）患者常受多种合并症影响。然而，关于PsA患者的呼吸道受累情况，已有相互矛盾的报道。本研究的目的是使用呼出一氧化氮分数（FeNO）作为气道炎症的间接标志物，评估非吸烟PsA患者与仅患银屑病患者相比是否存在亚临床气道炎症。
该研究纳入了164例非吸烟银屑病患者（银屑病面积和严重程度指数或PASI评分>10）：82例患有PsA，82例未患PsA，他们在不同流速（30、50、100、200 mL/s）下进行了FeNO测试。使用银屑病关节炎疾病活动评分（DAPSA）对PsA患者进行评估。比较了两个研究组的FeNO值及其与PASI评分的关联。通过Pearson系数评估变量之间的相关性。
与仅患银屑病但无关节炎的患者相比，PsA患者的FeNO水平更高（在30 mL/s时，71.09±18.40 ppb对66.88±19.12 ppb（无统计学差异）；在50 mL/s时，36.61±9.30 ppb对30.88±9.73 ppb（p<0.001）；在100 mL/s时，19.09±4.66 ppb对16.63±4.90 ppb（p<0.001）；在200 mL/s时，10.88±2.53 ppb对9.43±2.55 ppb（p<0.001））。仅在无关节炎的银屑病患者中，PASI评分与FeNO相关。然而，CASPAR指数与FeNO相关（FeNO30：r = 0.81，p<0.001；FeNO50：r = 0.84，p<0.001；FeNO100：r = 0.71，p<0.001；FeNO200：r = 0.58，p<0.001）。DAPSA与所有流速下的FeNO也相关（FeNO30：r = 0.43，p<0.001；FeNO50：r = 0.33，p<0.001；FeNO100：r = 0.34，p<0.001；FeNO200：r = 0.
