Abstract
Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.
Highlights
It was previously recognized as a rare condition, its prevalence among psoriatic patients was found to be high in a recent systematic review, ranging from 4.2% to 33.6%
The aim of this study was to determine the prevalence of psoriatic arthritis and associated variables among patients who had been diagnosed with plaque psoriasis at a teaching center in Juiz de Fora, MG, Brazil
Laboratory and radiographic evaluation The standardized medical records for each patient were reviewed and the following variables were evaluated: sex, age, family history of psoriasis, age at disease onset, duration of the disease, presence of psoriatic arthritis[11] and disease severity according to the Psoriasis Area and Severity Index (PASI).[12]
Summary
Psoriasis is a chronic inflammatory pathological condition of recurrent nature and multifactorial etiology that affects about 2% to 5% of people worldwide.[1,2] Currently, psoriasis is considered to be a systemic disease and it may be associated with several comorbidities, including psoriatic arthritis.[3,4,5,6] Psoriatic arthritis is a progressive disease, and some patients can progress to severe forms with joint damage and permanent functional changes.[5,6,7,8] it was previously recognized as a rare condition, its prevalence among psoriatic patients was found to be high in a recent systematic review, ranging from 4.2% to 33.6%.9 In addition, it is considered to be the comorbidity that has the greatest impact on the quality of life of these patients, requiring early diagnosis and treatment.[10]. In Brazil, the prevalence of psoriatic arthritis exclusively in patients with plaque psoriasis has not yet been defined. Given this context, and combined with the fact that skin lesions precede joint injuries in more than 80% of cases,[7,8,9] dermatologists have the opportunity to identify patients at risk and diagnose and treat them early
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