Gómez-Garcia Ignacio, García-Puga Teresa, Font-Ugalde Pilar, Puche-Larrubia Maria Angeles, Barbarroja Nuria, Ruiz-Limón Patricia, Escudero-Contreras Alejandro, Collantes-Estévez Eduardo, López-Medina Clementina
Department of Rheumatology, Reina Sofia University Hospital, Avda. Menendez Pidal s/n. Hospital Provincial, 14004 Córdoba, Spain.
Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain. University of Córdoba, Córdoba, Spain.
Ther Adv Musculoskelet Dis. 2022 Aug 22;14:1759720X221118055. doi: 10.1177/1759720X221118055. eCollection 2022.
The relationship of psoriasis and spondyloarthritis (SpA) is well-known, and the age of appearance of different manifestations has been described as a determinant of SpA phenotype. However, differences between Spa with psoriasis and psoriatic arthritis (PsA) are still controversial.
To evaluate whether the time of onset of psoriasis relative to the appearance of rheumatic symptoms in patients with SpA is associated with a clinical phenotype, a rheumatologist's diagnosis and the evolution of the disease.
This was a cross-sectional study with data extracted from the REGISPONSER (Spondyloarthritis Registry of the Spanish Rheumatology Society) registry.
All patients had data available for both psoriasis and SpA dates of onset. Patients were classified into two groups depending on the time of appearance of psoriasis: psoriasis before or after rheumatic symptoms. The clinical characteristics, disease activity, radiographic damage, functional ability and received treatments were compared between the two groups. Moreover, the rheumatologists' diagnoses were compared between the two groups. Univariate and multivariate logistic regressions were conducted to evaluate the factors associated with each group.
A total of 433/2367 (18.3%) patients included in the REGISPONSER database had psoriasis: 330 (76.2%) patients had psoriasis before rheumatic symptoms, and 103 (23.8%) had psoriasis after rheumatic symptoms. Patients with psoriasis before rheumatic symptoms had a shorter disease duration and a lower body mass index, a lower prevalence of both HLA-B27 antigens and anterior uveitis, a higher prevalence of dactylitis and an increase in levels of the erythrocyte sedimentation rate (ESR). Furthermore, a higher prevalence of PsA diagnoses (78.1% 56.4%) and a more frequent fulfilment of the CASPAR criteria (57.5% 42.2%) were found in these patients. The use of DMARDs was not significantly different between the two groups.
The time of appearance of psoriasis is associated with the clinical phenotype of SpA and could determine a diagnosis of PsA by rheumatologists.
银屑病与脊柱关节炎（SpA）之间的关系已为人熟知，不同表现出现的年龄被描述为SpA表型的一个决定因素。然而，伴有银屑病的SpA与银屑病关节炎（PsA）之间的差异仍存在争议。
评估SpA患者中银屑病发病时间相对于风湿症状出现时间是否与临床表型、风湿病学家的诊断及疾病进展相关。
这是一项横断面研究，数据来自REGISPONSER（西班牙风湿病学会脊柱关节炎登记处）登记库。
所有患者均有银屑病和SpA发病日期的数据。根据银屑病出现时间，患者被分为两组：风湿症状出现之前或之后出现银屑病。比较两组的临床特征、疾病活动度、影像学损伤、功能能力及接受的治疗。此外，比较两组风湿病学家的诊断。进行单因素和多因素逻辑回归以评估与每组相关的因素。
REGISPONSER数据库纳入的433/2367（18.3%）例患者患有银屑病：330例（76.2%）患者在风湿症状出现之前患有银屑病，103例（23.8%）在风湿症状出现之后患有银屑病。风湿症状出现之前患有银屑病的患者病程较短、体重指数较低，HLA - B27抗原和前葡萄膜炎的患病率较低，指（趾）炎患病率较高且红细胞沉降率（ESR）水平升高。此外，这些患者中PsA诊断的患病率更高（78.1%对56.4%），且更频繁地满足CASPAR标准（57.5%对42.2%）。两组间改善病情抗风湿药（DMARDs）的使用无显著差异。
银屑病出现的时间与SpA的临床表型相关，并可能决定风湿病学家对PsA的诊断。
