AB0568 CORRELATION BETWEEN SKIN AND JOINT INVOLVEMENT IN PATIENTS WITH PSORIATIC ARTHRITIS: EXPERIENCE FROM A THIRD LEVEL HOSPITAL
Authors: C. Sieiro Santos, C. Moriano, C. Álvarez Castro, X. E. Larco Rojas, E. Diez Alvarez, T. Pérez Sandoval
Journal: Annals of the Rheumatic Diseases (2021)

Background: Determining the relationship between severity of skin and joint disease is essential for better phenotyping of patients and determine whether clinical features of arthritis can associate with psoriasis. Objectives: To characterize the relationship between skin and joint activity in patients with psoriatic arthritis (PsA) and psoriasis (PsO) at enrolment. Methods: We performed a retrospective and descriptive study including patients diagnosed with PsA with a history of PsO. Age, sex, disease onset and duration, pattern of PsA and PsO, sites of skin and joint involvement were collected. PsA patients were evaluated at enrolment for skin activity by Psoriasis Area and Severity Index (PASI), joint activity by Disease Activity Score 28 (DAS28) for peripheral arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for axial involvement. A PASI&gt;10% was used to define moderate-severe psoriasis (MS-P). We compared clinical characteristics of patients with PsA based on PASI score and evaluated the relationship of skin and joint activity with linear regression. Results: A total of 50 patients were collected, 64% were women with a mean age of 57.4 ±11.9 years. Patients with MS-P had a long-standing history of PsO (16.6±7.9 vs 14.15±8.2 years, p 0.03) and arthritis (12.2±7.6 vs 10.6±7.6 years, p 0.05). PsO was diagnosed more frequently before arthritis in the group of MS-P (73% vs 42%, p 0.03). Nail (73% vs 34%, OR 4.27 (1.38-20.14), p 0.015) and hairline psoriasis (67% vs 29%, OR 5 (1.36-18.35), p 0.03) were more frequent in the group of MS-P. Polyarthritis was the most common clinical pattern (60% vs 26%, p 0.02) and peripheral arthritis, in shoulder, elbows and wrists was more associated to patients with MS-P. No significant difference regarding sex, age, arthritis onset, dactylitis, enthesitis or HLA-B27 was found. Patients with MS-P had a higher joint activity for peripheral arthritis (4.1 vs 2.44, p 0.02). The correlation between the skin and joint activity was positive and statistically significant r=0.568 (p 0.02), (graph 1). Conclusion: Patients with PsA with MS-P associate nail and hairline psoriasis, polyarthritis, and peripheral joint involvement more often. Cutaneous disease activity is correlated with joint activity. Collaboration between dermatologists and rheumatologists is recommended for a proper assessment of psoriatic arthritis with skin involvement. Graph 1. Correlation between skin and joint activity Table 1. Demographic and clinical characteristics of 50 patients PASI &lt;10% N = 35 PASI&gt; 10% N=15 OR 95%IC P value Age 54.4 ±10.4 53.9 ±12.9 - 0.86 Female 63% 73% 0.62 (0.16-2.34) 0.53 Duration of psoriasis 14.15 ±8.2 16.6±7.9 - 0.03 Duration of arthritis 10.6 ±7.4 12.2 ±7.6 - 0.05 Psoriasis onset 42% 73% 3.67 (1.97-13.8) 0.03 Arthritis onset 17% 20% 1.21 (0.26-5.64) 1 Nail psoriasis 34% 73% 4.27 (1.38-20.14) 0.015 Hair line 29% 67% 5 (1.36-18.35) 0.03 Enthesitis 14% 13% 1.08 (0.19-6.32) 0.96 Dactylitis 20% 33% 0.5 (0.13-0.96) 0.47 HLA B27 34% 13% 3.39 (0.66-17.56) 0.18 Type of arthritis Axial 26% 13% 0.44 (0.08-2.36) 0.47 Peripheral 42.8% 73% 6.88 (1.77-26.76) 0.05 Both 31% 13% 0.34 (0.06-1.75) 0.29 Joint involvement Back 14% 20% 0.67 (0.14-3.24) 0.68 Shoulders 17% 53% 5.52 (1.44-21.14) 0.02 Elbows 5.7% 33% 8.25 (1.38-49.21) 0.02 Wrists 31% 73% 6 (1.56-23.11) 0.01 Fingers 54% 60% 1.26 (0.37-4.32) 0.77 Knees 29% 47% 2.19 (0.63-7.65) 0.33 Ankles 40% 60% 2.25 (0.65-7.73) 0.22 Toes 46% 53% 1.36 (0.4-4.56) 0.76 Articular pattern Polyarthritis 26% 60% 4.33 (1.2-15.61) 0.02 Asymmetric oligoarthritis 29% 27% 0.91 (0.23-3.54) 1 DIP involvement 14.3% 13.3% 0.92 (0.16-5.39) 1 Spondyloarthritis 11.4% 13.3% 1.19 (0.19-7.33) 1 Arthritis mutilans - - - - DAS28 2.44 ±0.95 4.1±1.2 - 0.02 References: [1]Mease PJ, Etzel CJ, Huster WJ. Understanding the association between skin involvement and joint activity in patients with psoriatic arthritis: experience from the Corrona Registry. RMD Open. 2019 May 24;5(1):e000867. doi: 10.1136/rmdopen-2018-000867. PMID: 31245045; PMCID: PMC6560 Disclosure of Interests: None declared.