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Objective: to investigate the clinical and instrumental manifestations of axial psoriatic arthritis (axPsA) in combination with hyperuricemia (HU). Material and methods. The study included 71 patients with psoriatic arthritis (PsA): 59 (83%) men and 12 (17%) women. These patients had clinical and imaging evidence of inflammatory changes in the spine and were diagnosed with axPsA. The mean age of patients was 45.7±11.3 years, duration of psoriasis (Ps) was 209.3±163.4 months, and duration of PsA was 51.9±45.5 months. Patients underwent standard clinical, laboratory and radiological examinations. Patients completed the PsAID-12, FACIT-F and FiRST questionnaires and their LEI, MASES, DAPSA, BASDAI, BASFI, BASMI, ASDAS-CRP and BSA indices were assessed. Data on concomitant diseases and drug therapy were also collected. HU was diagnosed at uric acid (UA) level of >360 μmol/L. Patients were divided into two groups – with HU (group 1, n=24, 33.8%) and without HU (group 2, n=47, 66.2%). Results and discussion. The mean UA level was 329.96±80.2 μmol/l. The age of the patients, the duration of Ps and PsA were comparable in both groups. The activity of PsA and spondylitis in the two groups also did not differ. No significant differences were found between the groups in frequency of sacroiliitis or presence of erosions. In the 1st group, the total number of syndesmophytes in two sections of the spine was significantly higher (n=26, 108%) than in the 2nd group (n=39, 83%), p=0.04. In the group of patients with HU, there was a higher intensity of nocturnal spinal pain compared to the group without HU (5.0±2.7 and 3.6±2.8, respectively; p=0.04), more pronounced sleep disturbances (11±5.2 and 7±5.9; p=0.04), higher triglyceride levels (median 0.92 [0; 1.66] and 0.3 [0; 0.6]; p=0.03) and a higher frequency of hypertriglyceridemia (n=2, 8.3% and n=0; p=0.04) and liver steatosis (n=7, 29.1% and n=5, 10.6%; p=0.04, respectively). Patients with HU received antihypertensive therapy (n=10, 41.7% and n=14, 29.8% respectively; p=0.04) and urate-lowering medications (n=4, 16.6% and n=1, 2.1% respectively; p=0.02) significantly more often than patients without HU. Conclusion. HU was present in one third of patients with axPsA. They were more likely to have multiple syndesmophytes in the spine, metabolic disturbances, more severe nocturnal spinal pain and more pronounced sleep disturbances.
Objective: to investigate the clinical and instrumental manifestations of axial psoriatic arthritis (axPsA) in combination with hyperuricemia (HU). Material and methods. The study included 71 patients with psoriatic arthritis (PsA): 59 (83%) men and 12 (17%) women. These patients had clinical and imaging evidence of inflammatory changes in the spine and were diagnosed with axPsA. The mean age of patients was 45.7±11.3 years, duration of psoriasis (Ps) was 209.3±163.4 months, and duration of PsA was 51.9±45.5 months. Patients underwent standard clinical, laboratory and radiological examinations. Patients completed the PsAID-12, FACIT-F and FiRST questionnaires and their LEI, MASES, DAPSA, BASDAI, BASFI, BASMI, ASDAS-CRP and BSA indices were assessed. Data on concomitant diseases and drug therapy were also collected. HU was diagnosed at uric acid (UA) level of >360 μmol/L. Patients were divided into two groups – with HU (group 1, n=24, 33.8%) and without HU (group 2, n=47, 66.2%). Results and discussion. The mean UA level was 329.96±80.2 μmol/l. The age of the patients, the duration of Ps and PsA were comparable in both groups. The activity of PsA and spondylitis in the two groups also did not differ. No significant differences were found between the groups in frequency of sacroiliitis or presence of erosions. In the 1st group, the total number of syndesmophytes in two sections of the spine was significantly higher (n=26, 108%) than in the 2nd group (n=39, 83%), p=0.04. In the group of patients with HU, there was a higher intensity of nocturnal spinal pain compared to the group without HU (5.0±2.7 and 3.6±2.8, respectively; p=0.04), more pronounced sleep disturbances (11±5.2 and 7±5.9; p=0.04), higher triglyceride levels (median 0.92 [0; 1.66] and 0.3 [0; 0.6]; p=0.03) and a higher frequency of hypertriglyceridemia (n=2, 8.3% and n=0; p=0.04) and liver steatosis (n=7, 29.1% and n=5, 10.6%; p=0.04, respectively). Patients with HU received antihypertensive therapy (n=10, 41.7% and n=14, 29.8% respectively; p=0.04) and urate-lowering medications (n=4, 16.6% and n=1, 2.1% respectively; p=0.02) significantly more often than patients without HU. Conclusion. HU was present in one third of patients with axPsA. They were more likely to have multiple syndesmophytes in the spine, metabolic disturbances, more severe nocturnal spinal pain and more pronounced sleep disturbances.
Background. Psoriatic arthritis (PsA) is a complex immune-mediated disease in which a third of patients with psoriasis (PsO) have a inflammatory lesion of both the musculoskeletal system (peripheral joints and axial structures) and extra-articular manifestations (dactylitis, enthesitis, nail PsO, uveitis and inflammatory bowel disease). Aim. To assess the burden of PsA progression in real practice according to the Russian register of PsA patients. Materials and methods. Seven hundred thirty seven M/F=350 (47.5%)/387 (52.5%) patients with PsA from the Russian register of PsA patients were included. Mean age 47.412.7 yrs., duration of PsO 200.6158.9 mo., PsA 79.681.9 mo. All patients were divided into 2 groups by PsA duration: 1st gr 36 mo 288 (39.1%) and 2nd gr 36 mo 449 (60.9%). All patients underwent standard clinical examination of PsA activity. Tender (68) and swelling (66) joint count (TJC, SJC), DAPSA, LEI, tenderness of the plantar fascia, PsO BSA (%), PASI, HAQ-DI, PsAID-12, BMI (kg/m2), ESR (mm/h), CRP (mg/l) and comorbidities by ICD-10 were evaluated. Parametric and non-parametric methods of statistical analysis were used. All p0.05 were considered to indicate statistical significance. Results. In patients with PsA duration 36 mo we found significant prevalence of erosions by X-Ray, axial PsA, BMI30 kg/m2, HAQ-DI1, PsAID-124, arterial hypertension, metabolic syndrome and overall comorbidity (p0.05). There were no significant differences between groups in PsO severity by BSA3%, PASI1, LEI1, TJC, SJC, dactylitis, ESR30 mm/h, CRP10 mg/l, DAPSA, diabetes mellitus, hyperlipidemia, coronary heart disease and liver damage (p0.05). Сonclusion. Long-standing stage PsA is associated with erosions, axial PsA, worst health related quality of life, functional disability and increased cardio-metabolic disorders and overall comorbidity. Our results support the idea to start bDMARDs at early stage of PsA, it can improve better outcomes.
Aim. To develop an integral index of psoriatic arthritis (PsA) activity. Materials and methods. 117 patients with PsA (M/F 63/54) were included. Patients age 4411 years, psoriasis (Ps) duration 213153 months, PsA duration 73.478.5 months. Patients underwent standard clinical examination of PsA activity: tender (out of 68) and swollen (out of 66) joint counts (TJC, SJC), LEI, tenderness of the plantar fascia (PF), skin lesion severity (BSA), presence of nail Ps, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), DAPSA, FACIT-F. Parametric and nonparametric statistic methods, correlation and ROC analysis were used. Results. Mean DAPSA was 3821, TJC 14.210.6, SJC 10.68.3, ESR 30.529.5 mm/h, CRP 23.329 mg/l, LEI 1.21.5, FACIT-F 3211, BMI 27.46.2 kg/m2. The following significant positive correlations were revealed: between DAPSA and BMI, patients age, ESR, PsA and Ps duration, TJC, SJC, LEI, presence of PF enthesitis, skin lesion severity, presence of nail Ps. A negative correlation between FACIT-F and male sex was found. Based on the predictive model of parameters, the Entesial-Comorbid Index of PsA (ECIPsA) was created: 3.81LEI+13.72PF+0.54Age-0.25FACIT-F+7.36BSA+7.94PsA duration+5.5Nail Ps+0.32BMI-3.52, namely LEI Leeds Enthesial Index; PF pain in the PF; patients age; FACIT-F fatigue scale; BSA3%=0, 3%=1; PsA duration2 years=0, 2 years=1; presence of nail Ps=1, absence=0; ECIPsA28 corresponds with high PsA activity according to DAPSA28. ROC analysis of sensitivity and specificity of the prognostic model demonstrated high correctness of the index: the area under the ROC curve was 0.768, 95% confidence interval (0.6240.913). Conclusion. The new PsA activity index corresponds to the existing ones and takes into consideration the clinical heterogeneity and comorbidity of the disease.
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