| Psoriatic arthritis(PsA)is a chronic,progressive,inflammatory arthritis associated with psoriasis colsely.Psoriasis(PsO)is an inflammatory skin disease,characterized by the elbow and knee extensor surface expressing erythematosus skin lesions with scaly lupus,but may affect the scalp,hips,umbilical region,and other parts of the body.PsO occurs in 2%to 3%of the general population,about 30%of the patients with PsO will evolve into PsA.PsA has been identified as a kind of mild and benign arthritis,previously.Now the recognization about PsA has been changed in the past more than two decades by expansive clinical practice and deepening research.PsA will not only result in the joints and the surrounding soft tissue,performing from swelling,pain,stiffness,to deformity and movement disorders,and in the process of the disease will be accompanied by a variety of complications,such as cardiovascular disease,diabetes,dyslipidemia,obesity,metabolic syndrome,etc,which are seriously affect the patients' quality of life and prognosis.Therefore,it is equally important for rheumatologists and dermatologists to deeply understand the clinical features of the disease and then provide systematic and complete guidance for the diagnosis and treatment of the disease.In order to deepen our understanding of the disease,we will review the patient's medical records in the past four years,summarize the clinical features of PsA patients,and provide reference information for the diagnosis and treatment of the disease.According to classification of psoriatic arthritis(CASPAR criteria),the data of patients with PsA diagnosed by rheumatologists and dermatologists at Qilu Hospital of Shandong University from January 2014 to December 2017 were collected.The patients were followed-up by telephone of themselves and their families to further improve the data information.Retrospective analysis was conducted on the epidemiology,joint injury,skin performance,laboratory index,treatment plan,and evaluation of the patients.The proportion of men and women is 1.31:1.Patients which psoriatic lesions were the primary manifestations accounted for 66.67%,for the percentage of the arthritis as a starter was 16.05%,and 17.28%of the patients appeared at the same time.The average age of the patients with or without family history of psoriatic disease were 29.60 ± 13.42 years old and 34.77 ± 13.41 years old,respectively,and the difference was statistically significant(P<0.05).Psoriasis vulgaris,pustular psoriasis,and erythrodermic psoriasis were accounted for 91.40%,2.50%,and 6.20%,respectively.Clinical stage:The cases of stationary phase were 18.50%.Staying regress stage was 64.20%.The percentage of cases with regressive period was 14.30%.Classification of arthritis:Asymmetrical arthritis,symmetric polyarthritis,spine and sacroiliac joint lesions,distal joint type,and residual type accounted for 54.32%,7.41%,22.22%,14.81%,and 1.23%,respectively.There were statistically significant differences in the classification of PsO with different types and classifications of arthritis(x2 ?18.96,P<0.05)?(x2 =26.48,P=0.001).The difference in the positive incidence of human leukocyte antigen B27(HLA-B27)between peripheral arthritis and axial arthritis was statistically significant(X2=26.17,P<0.05).Psoriasis Area and Severity Index(PASI)and erythrocyte sedimentation rate(ESR)(r?0.255,P = 0.255)and C-reactive protein(CRP)(r = 0.196,P = 0.040),uric acid(UA)(r = 0.265,P = 0.007),low density lipoprotein-cholesterol(LDL-C)(r = 0.285,P?0.285),tenderness joint number(r = 0.261,P=0.261),tenderness joint score(r ?0.243,P = 0.243),the number of swollen joints(r = 0.294,P = 0.294),and swelling of the joints score(r = 0.325,P = 0.325)were positively correlated.It is negatively correlated with(RBC)(r=0.149,P=0.007)and hemoglobin(Hb)(r=-0.259,P=0.006).The total number of patients with non-steroidal antiinflammatory drugs(NSAIDs),corticosteroid hormones,disease modifying anti-rheumatic drugs(DMARDs),and biologic agents was 44.44%,8.64%,96.29%,and 35.80%,respectively.Clinical manifestation:1.The cases at the starting of PsO skin lesions are significantly higher than the those of arthritis.The incidence of patients with psoriatic family history is earlier than that of family history,which has a certain clinical significance for the monitoring of arthritis symptoms in patients with PsO.The majority of people with no obvious prodrome,and a few patients suffered from cold,fatigue,and mood changes,and more than half of the patients developed symptoms in winter.Psoriasis vulgaris is the main type of PsA,while the whole skin of body can be involved,of which scalp is the main body,following with limbs and trunk.Most of the patients are treated during the advanced stage of the disease,while the stationary phase and the regressive period are less,which may be related to the lack of attention of the patients.Asymmetrical arthritis is the most frequent type accomanied by the joints of hands are most common involved.The proximal interphalangeal joints are the most susceptible affected of those.More than two thirds of the patients showed a different degree of nails changes which can be used as one of the characteristic symptoms of other joint diseases.PsA often combines multiple complications including:Cardiovascular disease(especially in high blood pressure),liver and kidney function damage(light degree),eye disease,obesity,and metabolic syndrome(hyperlipidemia),etc.2.Laboratory indexes:ESR,CRP and joint tenderness,joint tenderness score,joint swelling number,and joint swelling were all positively correlated.PASI score was used to assess the severity of skin lesion,although it was almost seen in mild and moderate levels.However,with the increasing of PASI score,the patients will be accompanied by the increase of index of arthritis injury,the aggravating of anemia,and the increase of uric acid and serum lipid index.On the contrary,the higher the index of joint injury,the more severe the lesion of psoriatic lesions was observed.Therefore,to skin damage and joint damage comprehensive evaluation can reflect the extent to which patients more,ESR,CRP,PASI score,the degree of anemia,blood fat index,uric acid levels are available to assess disease in patients with PsA.At the same time,HLA-B27 positive was found in patients with different classification and classification of arthritis,but the positive rate of axial,spine and sacroiliac joint disease was significantly higher than that of other types.3.Treatment:The most widely used drug for PsA is DMARDs,and the differentiation of treatments in different departments is quiet considerable.Rheumatologists mainly use DMARDs combined with biologicals.Dermatologists mainly focus on DMARDs.Patients who are stay at severe and recurrent conditions may consider a small dose of glucocorticoid.It may affect the treatment and prognosis of patients in different degrees,so the cases of PsA needs joint,comprehensive evaluation,diagnosis,and treatment of rheumatologists and dermatologists. |
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