Periods of psoriatic arthritis onset and diagnosis in Russian patients with moderate to severe psoriasis (according to psoriasis patient registry)

Background: Early detection of psoriatic arthritis in patients with psoriasis remains an unmet medical need. Early diagnosis and treatment initiation in patients with psoriatic arthritis decreases the risk of adverse outcomes and improves patients quality of life. Aims: to describe a period between psoriasis and psoriatic arthritis onset and a period between psoriatic arthritis onset and diagnosis in Russian patients with moderate to severe psoriasis. Materials and methods: analysis of data from the psoriasis patient registry. Patients aged 18 years and older with an established diagnosis of psoriasis and psoriatic arthritis were included in the analysis. Exclusion criteria: no data on timing of psoriatic arthritis onset or diagnosis. Results: sample size for the descriptive characteristic of period between psoriasis and psoriatic arthritis onset was 891 patients; sample size for the descriptive characteristic of period between psoriatic arthritis onset and diagnosis was 849 patients. Psoriatic arthritis onset preceeded cutaneous manifestation of psoriasis in 2.5% of patients. Concurrent onset of cutaneous psoriasis and psoriatic arthritis (within one year) had 10.7% of patients. In 86.8% of patients, cutaneous manifestation of psoriasis preceded manifestation of psoriatic arthritis. Exclusively of patients with psoriatic arthritis developed before or concurrently with cutaneous manifestation of psoriasis, the mean duration of period between psoriasis and psoriatic arthritis onset was 13.7 10.3 years, the median [IQR] 12 [6-19] years. In 24% of patients with psoriatic arthritis the was 1 year or more after its onset. On average, in this subgroup of patients, psoriatic arthritis was diagnosed 3.95.0 years after the signs and/or symptoms onset. Median [IQR] of period between psoriatic arthritis onset and diagnosis was 2 [1-4.5] years. Conclusions: a diagnostic delay in 24% Russian patients with psoriatic arthritis is one year or more. The average delay in diagnosis of psoriatic arthritis is about 4 years.

Psoriatic erythroderma: comparative patient profile and association with psoriatic arthritis

Background: Psoriatic erythroderma is rare and the most severe form of psoriasis characterized by involvement of 80-90% of body surface area. Aims: to compare clinical and demographic characteristics of patients with psoriasis, depending on presence of psoriatic erythroderma in medical history; to assess the association between psoriatic arthritis and a history of psoriatic erythroderma. Materials and methods: patients aged 18 years and older with a duration of psoriasis of 10 years, from the psoriasis patients registry were included. Comparison of continuous quantitative variables was performed using t-test or Mann-Whitney U-test. The 2 test or Fisher's exact test was used to compare qualitative binary variables. The odds ratio of psoriatic arthritis in patients with and without a history of psoriatic erythroderma was calculated, unadjusted and adjusted for other independent variables. Results: The number of patients included in the analysis was 1,870. A history of psoriatic erythroderma (PE) had 227 (12.1%) of them. There were no significant differences in patient age at inclusion to the registry (47.113.1 years vs. 47.713.3 years), and prevalence of PE among men and women (12.6% vs. 11. 4%). Higher prevalence of arterial hypertension (47.9% vs 32.7%), angina pectoris (6.4% vs. 1.9%), myocardial infarction (3. 2% vs. 1.0%), biliary dyskynesia (14.3% vs. 3.9%), fatty liver (12.2% vs. 7.7%), cholelithiasis (8. 6% vs. 3.6%), and toxic liver disease (2.2% vs. 0.5%) among patients with vs without history of PE was found. Psoriatic arthritis was diagnosed in 67.0% patients with a history of psoriatic erythroderma. The odds of having psoriatic arthritis in patients with a history of psoriatic erythroderma were 4 times higher than in patients without erythroderma: 4.043 [2.975-5.493]. When adjusted for sex, age, duration of psoriasis, and body mass index, the odds ratio and statistical significance were maintained: 4.064 [2.939-5.619]. Conclusions: compared to patients without PE those with a history of psoriatic erythroderma have a greater comorbidity burden: a higher prevalence of cardiovascular diseases, diseases of the liver and biliary tract. A significant association between psoriatic arthritis and a history of PE was established.

The age at first cutaneous manifestation of psoriasis as a prognostic factor in the timing of psoriatic arthritis diagnosis

Background. Psoriatic arthritis is a chronic inflammatory disease of joints, spine and enthesis, which develops in 640% of patients with psoriasis and has a significant impact on the quality of life of patients. Aims. To determine the relationship between age of cutaneous manifestation of psoriasis and the timing of psoriatic arthritis diagnosis; to examine the possibility of prediction of timing of psoriatic arthritis diagnosis depending on age of cutaneous manifestation of psoriasis. Materials and methods. Data of patients aged 18 years and older with psoriatic arthritis included in the psoriasis patient register were analysed. Inclusion criteria were: patient age 18 years and older; established diagnosis of psoriasis and psoriatic arthritis. Exclusion criteria were: psoriatic arthritis diagnosed before or simultaneously with cutaneous manifestation of psoriasis; the age of the cutaneous manifestation of psoriasis older than 70 years. The sample included 771 patients. Spearman's correlation analysis was used to assess the correlation between age of cutaneous manifestation of psoriasis and period from skin psoriasis onset to psoriatic arthritis diagnosis. The possibility of prediction of the period till psoriatic arthritis was diagnosed depending on age at cutaneous manifestation of psoriasis was established by means of quantile regression analysis. Results. Mean age at cutaneous manifestation of psoriasis (SD) was 26.0 13.5 years. The period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis averaged 13.7 10.3 years, its median [interquartile range] was 12 [619] years. According to Spearman's correlation analysis, a moderate (close to strong) negative correlation between varibles was revealed (Spearman's correlation coefficient = 0.490, p 0.0005). In accordance to quantile regression analysis, lines of 5, 25, 50, 75 and 95% quantiles were obtained and the dependence of the period till the diagnosis of psoriatic arthritis on the age of onset of skin psoriasis was demonstrated. Based on the quantile equation obtained, a prognostic table for the period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis was compiled. Conclusions. Statistically significant inverse relationship between age of cutaneous manifestation of psoriasis and period till psoriatic arthritis diagnosis was established: older age at skin psoriasis onset is associated with shorter period till psoriatic arthritis diagnosis. Based on established relationship, presented as an equation, table and graphically, prediction of period till psoriatic arthritis diagnosis is possible. These results can be used in the clinical practice of dermatovenereologists.