Floris Alberto, Mugheddu Cristina, Sichi Leonardo, Dessì Martina, Anedda Jasmine, Frau Alessia, Pau Andrea, Lari Simone Aldo, Sorgia Jessica, Li Volsi Laura, Paladino Maria Teresa, Congia Mattia, Chessa Elisabetta, Angioni Maria Maddalena, Ferreli Caterina, Piga Matteo, Atzori Laura, Cauli Alberto
Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy.
Rheumatology Unit, Azienda Ospedaliero Universitaria di Cagliari, 09042 Monserrato, Italy.
J Clin Med. 2023 Sep 21;12(18):6090. doi: 10.3390/jcm12186090.
Aiming to identify the potential challenges in the classification of musculoskeletal manifestations in patients with psoriasis (PsO), this study analyzed the outcomes of a cross-sectional rheumatologic assessment of 1057 PsO patients. In total, 209 had a previous diagnosis of psoriatic arthritis (PsA). Out of the remaining 848 subjects, 293 (35%) were classified as suspected PsA cases according to the rheumatologist's judgment and/or Early PsA Screening Questionnaire score (EARP) ≥ 3. However, only 14% received a PsA diagnosis, 49% had a PsA-alternative diagnosis, and the remaining 37% had nonspecific arthralgias. Most of the newly diagnosed PsA patients had a symptoms duration ≥1 year (72%) and moderate disease activity (55%) with active oligoarthritis (85%), dactylitis, or enthesitis (35%) as the most frequent clinical pattern. The most frequent PsA-alternative diagnoses were osteoarthritis and fibromyalgia (44% and 41%). The only factors with significant ( < 0.05) utility in discriminating PsA from other diseases and nonspecific arthralgias were young age and EARP score with a history of morning stiffness, swollen joints, or dactylitis. These results demonstrated a high prevalence of suspected musculoskeletal symptoms in PsO patients, with, however, only a small proportion due to PsA. Close collaboration between the dermatologist and rheumatologist plays a crucial role in the differential diagnosis of PsA, as well as in monitoring nonspecific arthralgias for the potential transition to overt PsA.
为了确定银屑病（PsO）患者肌肉骨骼表现分类中的潜在挑战，本研究分析了1057例PsO患者的横断面风湿病评估结果。总共有209例曾被诊断为银屑病关节炎（PsA）。在其余848名受试者中，根据风湿病学家的判断和/或早期PsA筛查问卷评分（EARP）≥3，有293例（35%）被归类为疑似PsA病例。然而，只有14%的患者被诊断为PsA，49%的患者有PsA替代诊断，其余37%的患者有非特异性关节痛。大多数新诊断的PsA患者症状持续时间≥1年（72%），疾病活动度为中度（55%），最常见的临床模式为活动性少关节炎（85%）、指（趾）炎或附着点炎（35%）。最常见的PsA替代诊断是骨关节炎和纤维肌痛（分别为44%和41%）。在区分PsA与其他疾病和非特异性关节痛方面具有显著（<0.05）效用的唯一因素是年轻以及具有晨僵、关节肿胀或指（趾）炎病史的EARP评分。这些结果表明，PsO患者中疑似肌肉骨骼症状的患病率很高，然而，其中只有一小部分是由PsA引起的。皮肤科医生和风湿病学家之间的密切合作在PsA的鉴别诊断以及监测非特异性关节痛以预防其向显性PsA转变方面起着至关重要的作用。
