121例关节病型银屑病皮损和关节损伤特征的临床分析

Clinical features of skin lesions and joint injury in 121 patients with psoriatic arthritis

目的探讨关节病型银屑病(psoriatic arthritis,PsA)皮损和关节损伤的相关临床特征。方法按照CASPAR诊断标准入组121例PsA患者,对其入组时的临床资料进行回顾性分析。结果 121例PsA患者皮损初发病年龄平均(27.51±11.95)岁,关节炎初发病年龄平均(36.70±11.95)岁,82.64%患者以皮损为首发;92.56%患者表现为寻常型皮损,进展期占73.60%;83.47%患者为外周型,附着点炎合并滑膜炎占80.99%,最易受累的关节是手近端指间关节,并以第Ⅲ指近端指间关节最常见;外周型和中轴型PsA在银屑病皮损分型上差异有显著性统计学意义(P=0.001)。结论 PsA患者皮损发病年龄小于关节炎发病年龄,皮损主要表现为寻常型,关节损害主要累及外周动关节,以附着点炎合并滑膜炎为主,最常累及近端指间关节;中轴型PsA患者中,脓疱型和红皮病型发生率高于外周型。深入了解PsA皮损和关节损伤的特征,有利于PsA的早期诊断和规范化防治。

Objective To investigate the clinical features of skin lesions and joint injury associated with psoriatic arthritis （PsA）. Methods A retrospective analysis was performed of the baseline clinical data of 121 patients with PsA who were enrolled in this study according to CASPAR criteria. Results ①Onset status： The average age of first onset of skin lesions and arthritis was （27.51± 11.95） and （36.70± 11.95） years respectively. The incidence of PsA in which skin lesions antedated arthritis was 82.64%. ②Features of skin lesions in PsA： Vulgaris lesions were dominating among 92.56% of the patients. Patients withprogressive skin lesions accounted for 73.60%. ③Features of joint injury in PsA： Peripheral arthritis occurred in 83.47% of the cases. Enthesitis and synovitis were synchronously involved in 80.99% of the cases. The most susceptible joint was the proximal interphalangeal （PIP） joint, which was most common in the third finger. @）There was significant difference （P=0.001） in the classification of skin lesions for peripheral and axial PsA. Conclusion The onset of skin lesions occurs at a younger age than that of arthritis in patients with PsA. Skin lesions are mainly manifested as psoriasis vulgaris. Joint injury is mostly involved in peripheral motor diarthrosis and shows a significant proportion of enthesitis combined with synovitis. The most frequent joint involved in PsA is the PIP joint. Compared with peripheral arthritis, the occurrence of pustular and erythrodermic lesions is higher in patients with axial arthritis. In-depth understanding of the characteristics of skin lesions and joint injury in PsA is conducive to the early diagnosis and prevention of PsA.