Paroli Marino, Gioia Chiara, Accapezzato Daniele, Caccavale Rosalba
Clinical Immunology Unit, Department of Clinical Immunology, Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Sapienza University of Rome, 04100 Latina, Italy.
Internal Medicine Division, Department of Clinical Immunology, Department of Clinical, Anesthesiologic and Cardiovascular Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, 00161 Rome, Italy.
Medicina (Kaunas). 2025 Jun 6;61(6):1050. doi: 10.3390/medicina61061050.
Psoriatic arthritis (PsA) is a chronic rheumatic disease that is frequently associated with fibromyalgia (FM). The coexistence of FM complicates the evaluation of PsA disease activity and the planning of treatment strategies, as the two conditions share many overlapping clinical symptoms. To investigate the contribution of demographic factors and available serum biomarkers of inflammation and autoimmunity in characterizing the heterogeneity among patients meeting the classification criteria for both PsA and FM. : This cross-sectional, single-center study involved 1547 adult patients evaluated between January 2017 and December 2024 who met the CASPAR criteria for PsA. A patient subgroup also met the 2016 ACR criteria for FM. Demographic data, serum inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and autoimmunity markers including antinuclear antibodies (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPA) were evaluated. Statistical analyses included chi-square tests, -tests, Mann-Whitney U tests, and multivariate logistic regression to identify independent predictors associated with the coexistence of PsA and FM. A total of 254 patients (16.42%) were diagnosed with concomitant FM. Compared to patients with PsA alone, those with concurrent PsA and FM showed significantly lower C-reactive protein (CRP) levels (0.39 ± 0.74 vs. 2.88 ± 12.31 mg/dL; < 0.001) and a higher frequency of antinuclear antibody (ANA) positivity (13.57% vs. 5.78%; < 0.001). No significant differences were observed in rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA) positivity between the groups. Multivariate logistic regression identified female sex, ANA positivity, CRP levels ≤ 0.5 mg/dL, and elevated body mass index (BMI) as independent predictors of the presence of concomitant FM. : Patients with concomitant PsA and FM have a distinct demographic and serological profile, suggesting the existence of a clinically significant subgroup within the PsA population. Recognition of these differences may improve diagnostic accuracy and support the development of personalized, non-immunosuppressive therapeutic strategies for this subgroup of patients.
银屑病关节炎(PsA)是一种慢性风湿性疾病,常与纤维肌痛(FM)相关。FM的共存使PsA疾病活动度的评估和治疗策略的规划变得复杂,因为这两种疾病有许多重叠的临床症状。为了研究人口统计学因素以及炎症和自身免疫的现有血清生物标志物在表征符合PsA和FM分类标准的患者异质性方面的作用。:这项横断面单中心研究纳入了2017年1月至2024年12月期间评估的1547例成年患者,这些患者符合PsA的CASPAR标准。一个患者亚组也符合2016年FM的美国风湿病学会(ACR)标准。评估了人口统计学数据、血清炎症标志物如C反应蛋白(CRP)和红细胞沉降率(ESR),以及自身免疫标志物,包括抗核抗体(ANA)、类风湿因子(RF)和抗瓜氨酸化蛋白抗体(ACPA)。统计分析包括卡方检验、t检验、曼-惠特尼U检验和多变量逻辑回归,以确定与PsA和FM共存相关的独立预测因素。共有254例患者(16.42%)被诊断为合并FM。与仅患有PsA的患者相比,同时患有PsA和FM的患者C反应蛋白(CRP)水平显著更低(0.39±0.74 vs. 2.88±12.31mg/dL;P<0.001),抗核抗体(ANA)阳性频率更高(13.57% vs. 5.78%;P<0.001)。两组之间类风湿因子(RF)或抗瓜氨酸化蛋白抗体(ACPA)阳性率无显著差异。多变量逻辑回归确定女性、ANA阳性、CRP水平≤0.5mg/dL和体重指数(BMI)升高是合并FM存在的独立预测因素。:同时患有PsA和FM的患者具有独特的人口统计学和血清学特征,表明在PsA人群中存在一个具有临床意义的亚组。认识到这些差异可能会提高诊断准确性,并支持为该亚组患者制定个性化的、非免疫抑制的治疗策略。