Liu H L, He N, Dou L, Wang Y H, Su J M, Li M T, Leng X M, Zeng X F
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China.
Department of Rheumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005, China.
Zhonghua Nei Ke Za Zhi. 2022 Jul 1;61(7):779-784. doi: 10.3760/cma.j.cn112138-20220302-00152.
To investigate the relationship between psoriasis severity and clinical features in psoriatic arthritis (PsA). Patients were recruited from the Chinese REgistry of Psoriatic ARthritis (CREPAR) between December 2018 and June 2021, and data were collected including the baseline demographic characteristics, various clinical manifestations (including arthritis, nail disease, comorbidities), laboratory tests[including erythrocyte sedimentation rate(ESR), C-reactive protein (CRP)], health assessment questionnaire (HAQ). Body surface area (BSA) and psoriasis area and severity index (PASI) were selected for the tools of assessment of cutaneous psoriasis. Patients were divided to two groups, including the severe psoriasis group (BSA>10%) and the non-severe psoriasis group (BSA≤10%). Disease assessment included ankylosing spondylitis disease activity score (ASDAS), disease activity score 28 (DAS28) and disease activity in psoriatic arthritis (DAPSA). 1 074 eligible patients with PsA were recruited, and 106 (9.9%) had severe psoriasis. Compared with non-severe psoriasis group, the severe psoriasis group had more peripheral joint involvement (including patients with ever or current peripheral arthritis, 94.3% vs. 85.6%), more polyarticular joint involvement (including patients with current peripheral arthritis, 74.0% vs. 58.2%), more axial joint involvement (51.4% vs. 39.9%), more nail disease (72.6% vs. 61.4%), more frequency of smoking (20.2% vs. 18.7%), and higher proportion of hypertension (23.4% vs. 14.4%). In addition, the severe psoriasis group had higher level of ESR [33(10, 70) mm/1h vs. 20(9, 38) mm/1h] and CRP [18.6(5.0, 60.8) mg/L vs. 7.0(2.4, 18.1) mg/L], higher values of DAS28-ESR (4.5±1.7 vs. 3.7±1.5), DAS28-CRP (4.2±1.5 vs. 3.4±1.4), ASDAS-ESR (3.5±1.4 vs. 2.6±1.2), and ASDAS-CRP(3.4±1.6 vs. 2.5±1.2), higher scores of HAQ [0.6(0.1, 1.0) vs. 0.3(0.0, 0.8)]. Patients with PsA with severe psoriasis bore a heavier disease burden. Therefore, clinicians were supposed to pay more attention to them. In addition to skin lesions, they should also focus on examination of other clinical manifestations, such as joints and nails.
探讨银屑病关节炎（PsA）中银屑病严重程度与临床特征之间的关系。2018年12月至2021年6月期间，从中国银屑病关节炎注册研究（CREPAR）中招募患者，收集的数据包括基线人口统计学特征、各种临床表现（包括关节炎、指甲病变、合并症）、实验室检查[包括红细胞沉降率（ESR）、C反应蛋白（CRP）]、健康评估问卷（HAQ）。选择体表面积（BSA）和银屑病面积和严重程度指数（PASI）作为评估皮肤银屑病的工具。患者分为两组，包括重度银屑病组（BSA>10%）和非重度银屑病组（BSA≤10%）。疾病评估包括强直性脊柱炎疾病活动评分（ASDAS）、疾病活动评分28（DAS28）和银屑病关节炎疾病活动度（DAPSA）。共招募了1074例符合条件的PsA患者，其中106例（9.9%）患有重度银屑病。与非重度银屑病组相比，重度银屑病组有更多的外周关节受累（包括既往或目前有外周关节炎的患者，94.3%对85.6%）、更多的多关节受累（包括目前有外周关节炎的患者，74.0%对58.2%）、更多的中轴关节受累（51.4%对39.9%）、更多的指甲病变（72.6%对61.4%）、更高的吸烟频率（20.2%对18.7%）以及更高的高血压患病率（23.4%对14.4%）。此外，重度银屑病组的ESR水平更高[33（10，70）mm/1h对20（9，3）mm/1h]和CRP水平更高[18.6（5.0，60.8）mg/L对7.0（2.4，18.1）mg/L]，DAS28-ESR（4.5±1.7对3.7±1.5）、DAS28-CRP（4.2±1.5对3.4±1.4）、ASDAS-ESR（3.5±1.4对2.6±1.2）和ASDAS-CRP（3.4±1.6对2.5±1.2）的值更高，HAQ评分更高[0.6（0.1，1.0）对0.3（0.0，0.）]。患有重度银屑病的PsA患者疾病负担更重。因此，临床医生应给予他们更多关注。除了皮肤病变外，还应关注其他临床表现的检查，如关节和指甲。
