| Background and ObjectivePsoriatic arthritis(PsA),belonging to SpA(spondyloarthropathy),is a systemic immune-mediated and inflammatory disorder,which is heterogeneous in presentation and clinical course.The clinical manifestations of PsA are complex,including a series of inflammatory changes,such as erythema and scales of psoriatic lesions,nail lesions,enthesitis,synovitis,ulcerative colitis and iris or ciliary body inflammation.PsA is mainly characterized as psoriatic lesions and joint inflammation.The skin lesions of PsA can be manifested as vulgaris,erythrodermic and pustular.The joint injury often causes pain and swelling of the joints and surrounding soft tissue,as well as stiff and dyskinesia.The prolonged course and recurrent usually make things worse,leading to progressive aggravation of the condition.Thus,the outcome of PsA is impaired functional capacity,reduced quality of life and social communication,making patients suffer a lot.This study focused on the analysis of the clinical features and laboratory indicators in PsA,so as to deepen the cognition on the etiology and pathological mechanism of PsA.We aim to provide a theoretical basis for the formulation of the PsA classification and evaluation standards in line with Chinese national conditions,and to accumulate experience in effective prevention and treatment of PsA to improve its prognosis.Methods According to CASPAR criteria of PsA,we screened 121 patients with PsA from Department of Dermatology in Air Force General Hospital from July 2013 to December2015.The data of medical history,physical examination and laboratory examinations atbaseline were statistically analyzed and were compared with 58 patients with psoriasis vulgaris and 70 healthy individuals.Statistical analysis was carried out with the software 17.0 by t-test,one–way analysis of variance(ANOVA),least significant difference(LSD)test and Kruskal-Wallis test,Wilcoxon signed rank sum test,Chi-square test and Spearman correlation analysis.Results1 Basic conditions:(1)One hundred and twenty-one patients with PsA were enrolled in this study.69 cases were male,and 52 were female,with the ratio of male to female being 1.33:1.The average age was(41.29±12.42)years.The average age of first onset in skin lesions and in arthritis was(27.51±11.95)and(36.70±11.95)years respectively.(2)The incidence of PsA whose skin lesions antedated arthritis was 82.64%(100/121).The patients whose arthritis preceding skin lesions accounted for 4.96%(6/121).The remaining was 12.40%(15/121).2 Skin lesions in PsA:(1)Types of skin lesions: Vulgaris psoriasis predominated 92.56%(112/121)PsA patients,while psoriasis pustulosa and erythrodermic psoriasis accounted for 4.13%(5/121)and 3.31%(4/121)respectively.(2)Stages of skin lesions: Skin lesions in progressive stage were seen in 89(73.55%)cases.21(17.36%)cases were in static skin lesions.11(9.10%)cases were in regressive stage.(3)Severity of skin lesions: PASI score was 0.30~50.10.The average score was11.80(13.30).Mild(0<PASI<10),moderate(10?PASI<30)and severe(PASI?30)cases were 51(42.15%),60(49.59%),9(7.44%)respectively.3 Joint injury in PsA:(1)Peripheral arthritis occurred to 83.47%(101/121)patients,and the most common joint involved in the peripheral PsA was the proximal interphalangeal(PIP)joint on the third finger.Axial arthritis occurred to 16.53%(20/121),and arthritis of PIP joint on the third toe was the most frequently involved in this group.(2)Enthesitis and synovitis were synchronously involved in 80.99%(98/121)patients.6.61%(8/121)were pure enthesitis and 12.40%(15/121)were pure synovitis.The most susceptible joint involved in enthesitis combined with synovitis was PIP joints,which was most common seen on the third finger.The most affected joint involved in pure enthesitis and pure synovitis was heel and knee joint respectively.4 The relationship between skin and joint damage in PsA: There was a significant difference(P=0.001)in the types of skin lesions for peripheral arthritis and axial arthritis,but no difference(P=0.608)in the stages of skin lesions.Compared with peripheral arthritis,the occurrence of pustular and erythrodermic lesion was higer in patients with axial arthritis.5 Characteristics of system damage: PsA was usually accompanied by abnormal blood glucose and lipid metabolism and hematopoietic function abnormalities,whose characteristics differed from that of PV.(1)UA: UA was significantly higher in PsA than in the control group.(P <0.05).(2)Glucose metabolism:FBS was significantly higher in PsA than in PV and the control group(both P <0.05).(3)Lipid metabolism: The levels of TG,APOA?and APOB100 in Ps A group increased significantly,but HDL-C decreased significantly(each P<0.05).While TC,LDL-C,HDL-C,APOB100 of PV were significantly lower than those of the control group(each P<0.05).(4)Hematopoietic function abnormalities : RDW in patients with PsA decreased significantly(P=0.000).There was no difference in MCV,MCH,MCHC between PsA and the control group(each P>0.05).RDW of PV group decreased significantly,whileMCV?MCH?MCHC increased significantly(each P=0.000).PLT in peripheral blood of PsA was higher than in that of PV and the control group(both P=0.000).MPV in PsA was lower than in the control group,but was higher than in PV(both P<0.05).WBC and NEUT in PsA were higher than in PV and the control group(each P<0.01).6 Evaluation indicators of PsA:(1)Evaluation indicators of skin lesions: PASI was positively correlated with ESR(r=0.19,P=0.045),CRP(r=0.251,P=0.007),hs-CRP(r=0.247,P=0.049)and UA(r=0.217,P=0.018)in PsA.(2)Evaluation indicators of joint injury: IL-6 was positively correlated with tender joints(r=0.314,P=0.001),tenderness score(r=0.332,P=0.001),tenderness score(r=0.264,P=0.006)and swelling joints and swelling joint score(r=0.292,P=0.003).hs-CRP was positively correlated with tender joints(r=0.391,P=0.002),tenderness score(r=0.403,P=0.001),swelling joints(r=0.225,P=0.078)and swelling joint score(r=0.212,P=0.098).CRP was positively correlated with tender joints(r=0.287,P=0.002),tenderness score(r=0.260,P=0.006),tenderness score(r=0.196,P=0.040).The degree of joint tenderness was negatively correlated with HDL-C(tender joints:r=-0.232,P=0.014;tenderness score:r=-0.218,P=0.021).Summary(1)In most patients with PsA,skin lesions antedates arthritis.Skin lesions are mainly manifested as psoriasis vulgaris and are mostly in progressive stage.The severity of skin lesions in most patients is mild to moderate.(2)Joint injury mainly involves in peripheral motor diarthrosis and shows a significant proportion of enthesitis combined with synovitis.The most frequent joint involved in PsA is PIP joint.(3)The proportion of pustular and erythrodermic lesions in axial PsA is higher than in peripheral PsA.(4)The types of skin lesions in axial PsA were mainly pustular and erythrodermic lesions.The proportion of vulgaris lesions in peripheral PsA is higher than in axial PsA.(5)PsA is usually accompanied by abnormal glucose and lipid metabolism,whose characteristics differ from PV.UA is significantly higher in PsA than in the control group,but was significantly lower than in PV.FBS was significantly higher in PsA than in PV and in the control group.There are some significantly increases in the levels of TG,APOA?and APOB100 in PsA,but there is a decrease in HDL-C.(6)PsA are usually associated with abnormal hematopoietic function.The type of anemia in PsA is normal cell homogeneity anemia.(7)To a certain degree,three inflammatory markers including ESR,CRP,hs-CRP and UA can reflect the inflammatory activity of skin lesions in PsA.IL-6,hs-CRP and HDL-C can be used as referential indicators to evaluate the inflammatory activity of joints.Deepening the understanding of the clinical characteristics of PsA and clinical significance of change in laboratory indicators is conducive to the early diagnosis,evaluation,standardized prevention and treatment of PsA. |
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