Reina Sofia University Hospital, Córdoba/Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain.
Rheumatology Department, Cochin Hospital from Paris/INSERM U 1153, Clinical Epidemiology and Biostatistics, Paris, France.
Rheumatology (Oxford). 2021 Mar 2;60(3):1125-1136. doi: 10.1093/rheumatology/keaa398.
To evaluate whether the presence of psoriasis influences the clinical expression, disease activity and disease burden in both axial and peripheral phenotypes of spondyloarthritis (SpA).
Patients from the Spanish REGISPONSER registry classified as having SpA according to the ESSG criteria were included. Patients were classified as psoriatic or non-psoriatic depending on the presence of cutaneous or nail psoriasis; thereafter, they were classified as having either axial [presence of radiographic sacroiliitis OR inflammatory back pain (IBP)] or peripheral phenotype (absence of radiographic sacroiliitis AND absence of IBP AND presence of peripheral involvement). Pair-wise univariate and multivariate analyses among the four groups (psoriatic/non-psoriatic axial phenotypes and psoriatic/non-psoriatic peripheral phenotypes) were performed with adjustment for treatment intake.
A total of 2296 patients were included in the analysis. Among patients with axial phenotype, psoriasis was independently associated (P < 0.05) with HLA-B27+ [odds ratio (OR) 0.27], uveitis (OR 0.46), synovitis (ever) (OR 2.59), dactylitis (OR 2.78) and the use of conventional synthetic DMARDs (csDMARDs) (OR 1.47) in comparison with non-psoriatic patients. Among patients with peripheral phenotype and adjusting for csDMARD intake, psoriasis was independently associated with higher age at disease onset (OR 1.05), HLA-B27+ (OR 0.14) and heel enthesitis (OR 0.22). Higher scores for patient-reported outcomes and greater use of treatment at the time of the study visit were observed in psoriatic patients with either axial or peripheral phenotype.
These findings suggest that, among all patients with SpA, psoriasis is associated with differences in clinical expression of SpA, a greater disease burden and increased use of drugs.
评估银屑病的存在是否会影响脊柱关节炎（SpA）中轴型和外周型的临床表现、疾病活动度和疾病负担。
纳入了根据 ESSG 标准被分类为 SpA 的西班牙 REGISPONSER 登记处的患者。根据是否存在皮肤或指甲银屑病，将患者分类为银屑病或非银屑病；然后，他们被分类为中轴型[存在放射学骶髂关节炎或炎症性背痛（IBP）]或外周型（无放射学骶髂关节炎且无 IBP 且存在外周受累）。对四组（银屑病/非银屑病中轴型和银屑病/非银屑病外周型）进行了调整治疗摄入的两两单变量和多变量分析。
共纳入 2296 名患者进行分析。在中轴型患者中，银屑病与 HLA-B27+（比值比[OR]0.27）、葡萄膜炎（OR0.46）、滑膜炎（既往）（OR2.59）、指炎（OR2.78）和传统合成 DMARDs（csDMARDs）（OR1.47）的使用独立相关（P<0.05），与非银屑病患者相比。在调整 csDMARD 摄入量的外周型患者中，银屑病与发病年龄较高（OR1.05）、HLA-B27+（OR0.14）和跟腱附着点炎（OR0.22）独立相关。在中轴型或外周型的银屑病患者中，观察到患者报告的结局评分更高，并且在研究就诊时使用的治疗方法更多。
这些发现表明，在所有 SpA 患者中，银屑病与 SpA 的临床表现、疾病负担更大和药物使用增加有关。
