Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Arthritis Res Ther. 2023 Aug 9;25(1):145. doi: 10.1186/s13075-023-03119-2.
Axial spondyloarthritis (axSpA) is known to be associated with several extra-skeletal manifestations (ESM), including the inflammatory skin disease psoriasis. It is important to recognize and diagnose psoriasis timely in axSpA in order to provide optimal treatment and outcome for both axSpA and psoriasis.
In this observational study, all patients from the Dutch Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort included before June 2016 were sent a questionnaire with self-screening psoriasis questions including prototypical color pictures.
Of the 592 questionnaires sent, 448 (75.7%) were eligible for analysis. Of these 448 respondents, 58 (13%) had a positive self-screening for psoriasis symptoms, currently or in the past. In 28 (48%) of 58 patients, psoriasis diagnosis could be verified by medical records, resulting in a psoriasis prevalence rate of 6.3%. In comparison with patients with a confirmed psoriasis diagnosis, patients reporting psoriasis symptoms without a verified diagnosis mentioned more mild than moderate-severe psoriasis symptoms (25% vs. 3%, p = 0.02), and their psoriasis lesions were less often located on the torso area (3% vs. 18%, p = 0.04), the intergluteal cleft (0% vs. 25%, p = 0.02), and legs (7% vs. 43%, p < 0.01). Of the 31 axSpA patients who reported currently active psoriasis, 74% had only mild psoriasis symptoms.
Especially mild psoriasis seems often underdiagnosed in patients with axSpA using a patient questionnaire with prototypical pictures of psoriasis lesions. This questionnaire could be beneficial in tracing patients with undiagnosed psoriasis in daily clinical practice. As a next step, further validation of this questionnaire is needed.
已知强直性脊柱炎（axSpA）与多种骨骼外表现（ESM）相关，包括炎症性皮肤病银屑病。在 axSpA 中及时识别和诊断银屑病对于为 axSpA 和银屑病提供最佳治疗和结果非常重要。
在这项观察性研究中，2016 年 6 月之前纳入荷兰格罗宁根-吕伐登轴向脊柱关节炎（GLAS）队列的所有患者均收到一份调查问卷，其中包括自我筛查银屑病问题和典型的彩色图片。
在发出的 592 份问卷中，有 448 份（75.7%）符合分析条件。在这 448 名应答者中，有 58 名（13%）目前或过去有银屑病症状的阳性自我筛查。在 28 名（48%）患者中，通过病历可证实银屑病诊断，因此银屑病的患病率为 6.3%。与确诊银屑病的患者相比，报告有银屑病症状但未确诊的患者更常报告轻度而非中重度银屑病症状（25%比 3%，p=0.02），其银屑病病变更常位于躯干区域（3%比 18%，p=0.04）、臀间裂（0%比 25%，p=0.02）和腿部（7%比 43%，p<0.01）。在 31 名报告目前有活动性银屑病的 axSpA 患者中，74%的患者仅有轻度银屑病症状。
使用包含银屑病病变典型图片的患者问卷，在 axSpA 患者中，尤其轻度银屑病似乎经常漏诊。该问卷在日常临床实践中有助于发现未诊断的银屑病患者。下一步需要进一步验证该问卷。
