Single article

Bashkova I., Koltsova I.

Revisiting Psoriatic Arthritis Detection in Patients with Psoriasis in a Dermatological Hospital

Keywords: psoriasis, psoriatic arthritis, mPEST questionnaire, detectability, comorbid diseases, insufficient diagnostics

The incidence of psoriatic arthritis (PsA) is increasing annually; the number of disabling cases of the disease grows as well. A dermatologist becomes the first contact physician for a patient with psoriasis, on whom timely detection of clinically manifest PsA signs and referral to a rheumatologist depend. The aim of this work was to perform PsA detectability analysis and to study the prevalence of comorbid diseases in psoriasis patients treated in a dermatological in-patient hospital. The study engaged 45 patients (including 13 women) with various clinical forms of psoriasis from among in-patients of the Republican dermatovenerologic dispensary of the town of Cheboksary. The examinees' median age was 49,3±12,8 years. Based on the mPEST screening questionnaire, PsA diagnosis was suspected in 20 (44,4%) patients, with 18 patients meeting the CASPAR disease classification criteria. Only 5 patients were diagnosed with PsA earlier, and the remaining patients, despite the symptoms of damage to the musculoskeletal system, were never consulted by a rheumatologist and were observed only in a dermatological clinic. Peripheral arthritis was detected in 22.2%, enthesites – in 33,3%, dactylites – in 33.3%, spondylites – in 8.9% of psoriasis patients. In 68.9% of psoriasis patients, concomitant diseases were detected. Diseases of the cardiovascular system (51,1% of cases) and gastrointestinal tract (33,3% of cases) were the most frequently reported. Almost 2/3 of the patients (62,3%) were overweight/obese. The rate of undiagnosed PsA among psoriasis patients treated in the dermatological in-hospital was 28,9%. Increasing the frequency of PsA detectability can be achieved through active using screening questionnaires by dermatologists, these questionnaires being aimed at identifying clinically manifest signs of damage to the bone and joint apparatus in psoriasis patients, and through developing the ways to route patients to be consulted by a rheumatologist.

References

  1. Abdulganieva D.I., Bakulev A.L., Belousova E.A. i dr. Proekt mezhdistsiplinarnykh rekomendatsii po diagnostike, metodam otsenki stepeni aktivnosti, terapevticheskoi effektivnosti i primeneniyu genno-inzhenernykh biologicheskikh preparatov u patsientov s sochetannymi immunovospalitel’nymi zabolevaniyami (psoriaz, psoriaticheskii artrit, bolezn’ Krona) [Draft interdisciplinary guidelines for diagnosis, methods for estimation of the degree of activity, for evaluation of therapeutic efficacy and for use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn’s disease). Sovremennaya revmatologiya, 2018, no. 3, pp. 4–18. DOI: 14412/1996-7012-2018-3-4-18.
  2. Batkaeva N.V., Korotaeva T.V., Batkaev E.A. Rasprostranennost’ psoriaticheskogo artrita i komorbidnykh zabolevanii u bol’nykh tyazhelym psoriazom: dannye retrospektivnogo analiza gospital’noi kogorty [Prevalence of psoriatic arthritis and comorbidities in patients with severe psoriasis: Data of a retrospective analysis of a hospital cohort]. Sovremennaya revmatologiya, 2017, 1, pp. 19–22. DOI: 10.14412/1996-7012-2017-1-19-22.
  3. Korotaeva T.V., Korsakova Yu.L. Psoriaticheskii artrit: klassifikatsiya, klinicheskaya kartina, diagnostika, lechenie [Psoriatic arthritis: classification, clinical presentation, diagnosis, treatment]. Nauchno-prakticheskaya revmatologiya, 2018, no. 1, pp. 60–69. DOI: 14412/1995-4484-2018-60-69
  4. Lila A.M., Nasonov E.L., Korotaeva T.V. Psoriaticheskii artrit: patogeneticheskie osobennosti i innovatsionnye metody terapii [Psoriatic arthritis: pathogenetic features and innovative therapies]. Nauchno-prakticheskaya revmatologiya, 2018, no. 6, pp. 685–691. DOI: 10.14412/1995-4484-2018-685-691.
  5. Chamurlieva M.N., Korotaeva T.V., Loginova E.Yu., Batkaev E.A. Algoritm diagnostiki psoriaticheskogo artrita v klinicheskoi praktike dermatologa [Diagnostic algorithm for psoriatic arthritis in clinical practice of dermatologist]. Rossiiskii zhurnal kozhnykh i venericheskikh boleznei, 2016, no. 1, pp. 36–40. DOI: 10.18821/1560-9588-2016-19-1-36-40.
  6. Chamurlieva M.N., Loginova E.Yu., Korotaeva T.V. Vyyavlyaemost’ perifericheskikh i aksial’nykh proyavlenii psoriaticheskogo artrita u bol’nykh psoriazom v dermatologicheskoi praktike [Detectability of the peripheral and axial manifestations of psoriatic arthritis in patients with psoriasis in dermatological practice]. Sovremennaya Revmatologiya, 2019, no. 4, pp. 48–54. DOI: 10/14412/1996-7012-2019-4-48-54.
  7. Chamurlieva M.N., Loginova E.Yu., Korotaeva T.V., Batkaev E.A. Porazhenie kostno-sustavnogo apparata u bol’nykh psoriazom po dannym skriningovogo oprosnika PEST (Psoriasis Epydemiology Screening Tool) i revmatologicheskogo kliniko-instrumental’nogo obsledovaniya [Osteoarticular injury in psoriatic patients according to the data of PEST (Psoriasis Epidemiology Screening Tool) questionnaire and rheumatological clinicoinstrumental examination]. Nauchno-prakticheskaya revmatologiya, 2014, no. 6, pp. 636–642. DOI: 10.14412/1995-4484-2014-636-642.
  8. Armstrong A.W., Harskamp C.T., Armstrong E.J. Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis. JAMA Dermatol, 2013, vol. 149, no. 1, pp. 84–91. DOI: 10.1001/2013.jamadermatol.406.
  9. Arumugam R., McHugh N.J. Mortality and causes of death in psoriatic arthritis. Rheumatol., 2012, vol. 89, pp. 32–35. DOI: 10.3899/jrheum.120239.
  10. Buckley C., Cavill C., Taylor G. et al. Mortality in psoriatic arthritis – a singlecenter study from the UK. Rheumatol., 2010, vol. 37, pp. 2141–2144. DOI: 10.3899/jrheum.100034.
  11. Fredriksson T., Pettersson U. Severe psoriasis–oral therapy with a new retinoid. Dermatologica, 1978, vol. 157, 4, pp. 238–244. DOI: 10.1159/000250839.
  12. Gisondi P., Altomare G., Ayala F. et al. Consensus on the management of patients with psoriatic arthritis in a dermatology setting. Eur. Acad. Dermatol. Venereol., 2018, vol. 32, no. 4, pp. 515–528. DOI: 10.1111/jdv.14741.
  13. Gladman D.D., Chandran V. Observational cohort studies: lessons learnt from the University of Toronto Psoriatic Arthritis Program. Rheumatology (Oxford), 2011, vol. 50, no. 1, pp. 25–31. DOI: 10.1093/rheumatology/keq262.
  14. Horreau C., Pouplard C., Brenaut E. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. Eur. Acad. Dermatol. Venereol., 2013, suppl. 3, pp. 12–29. DOI: 10.1111/jdv.12163.
  15. Mehta N.N., Azfar R.S., Gelfand J.M. et al. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Heart J., 2010, vol. 31, no. 8, pp. 1000–1006. DOI: 10.1093/eurheartj/ehp567.
  16. Olivieri I., Padula A., D’Angelo S. et al. Psoriatic arthritis sine psoriasis. Rheumatol., 2009, suppl. 83, pp. 28–29.
  17. Reich K., Krüger K., Mössner R., Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaquetype psoriasis. J. Dermatol., 2009, vol. 160, no. 5, pp. 1040–1047. DOI: 10.1111/j.1365-2133.2008.09023.
  18. Ritchlin C.T., Colbert R.A., Gladman D.D. Psoriatic Arthritis. Engl. J. Med., 2017, vol. 376, pp. 957–970. DOI: 10.1056/NEJMra1505557.
  19. Sommer D.M., Jenisch S., Suchan M. et al. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Dermatol. Res., 2006, vol. 298, no. 7, pp. 321– 328.
  20. Spelman L., Su J.C., Fernandez-Penas P. et al. Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice. Eur. Acad. Dermatol. Venereol., 2015, vol. 29, pp. 2184–2191. DOI: 10.1111/jdv.13210.
  21. Veale D.J., Fearon U., Eder L. et al. The incidence and risk factors for psoriatic arthritis in patients with psoriasis: a prospective cohort study. Arthritis Rheum, 2016, vol. 68, pp. 915–9 DOI: 10.1002/art.39494.
  22. Villani A., Rouzaud M., Sevrain M. et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and metaanalysis. Am. Acad. Dermatol., 2015, vol. 73, pp. 242–248. DOI: 10.1016/j.jaad.2015.05.001.
  23. Villani A., Rouzaud M., Sevrain M. Symptoms dermatologists should look for in daily practice to improve detection of psoriatic arthritis in psoriasis patients: an expert group consensus. Eur. Acad. Dermatol. Venereol., 2014, suppl 5, pp. 27–32. DOI: 10.1111/jdv.12563.
  24. Wenk K.S., Arrington K.C., Ehrlich A. Psoriasis and non-alcoholic fatty liver disease. Eur. Acad. Dermatol. Venereol., 2011, vol. 25, no. 4, pp. 383–391. DOI: 10.1111/j.1468-3083.2010.03841.
  25. Yeung H., Takeshita J., Mehta N.N. et al. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol., 2013, vol. 149, no. 10, pp. 1173–1179. DOI: 10.1001/jamadermatol.2013.5015.

About authors

Bashkova Inna Yu.
Rheumatologist, Federal Center of Traumatology, Orthopedics and Endoprosthetics; Candidate of Medical Sciences, Associate Professor, Department of Faculty and Hospital Therapy , Chuvash State University, Russia, Cheboksary (innabashkova@yandex.ru)
Koltsova Irina
6th Year Student, Medicine Faculty, Chuvash State University, Russia, Cheboksary (irina_renins@mail.ru)

Article link

Bashkova I., Koltsova I. Revisiting Psoriatic Arthritis Detection in Patients with Psoriasis in a Dermatological Hospital [Electronic resource] // Acta medica Eurasica. – 2019. – №4. P. 1-11. – URL: http://acta-medica-eurasica.ru/en/single/2019/4/1/.