脊柱关节病型银屑病关节炎疾病活动度的相关影响因素分析

Influencing factors of joint involvement in spondyloarthropathic psoriatic arthritis

目的分析脊柱关节病型银屑病关节炎关节受累的影响因素,寻找早期发现该病的可能指标。方法回顾性选取2016年9月至2022年2月就诊于首都医科大学附属北京友谊医院风湿内科及皮肤科的358例银屑病关节炎的患者作为研究对象,根据受累部位不同将患者分为脊柱关节病型银屑病关节炎组(n=117)和外周关节病银屑病关节炎组(n=241)。根据强直性脊柱炎疾病活动(ASDAS)评分对脊柱关节病型银屑病关节炎患者进行疾病活动度分组,疾病轻度活动组(ASDAS<2.1,n=47),重度活动组(ASDAS≥2.1,n=70)。分析影像学分级、银屑病面积与严重性指数(PASI)评分、格拉斯哥超声附着点评分系统(GUESS)评分、自身抗体、炎症指标等与脊柱关节病型银屑病关节炎疾病活动度之间的相关性。结果脊柱关节病型银屑病关节炎组患者的眼部受累的比率、HLA-B27阳性率、红细胞沉降率(ESR)、GUESS评分分别为14.5%、20.1%、(21.8±16.6)mm/h、(23.0±12.1)分,高于外周关节病变型银屑病关节炎组[6.2%、10.4%、(34.6±21.3)mm/h、(9.5±10.3)分],差异均有统计学意义(P<0.05)。在脊柱关节病型银屑病关节炎患者中,轻度活动组与重度活动组骶髂关节CT分级差异无统计学意义(P>0.05);重度活动组患者PASI评分、GUESS评分为(14.5±9.1)、(12.8±9.6)分,均高于轻度活动组[(10.6±6.1)、(2.2±3.4)分],差异均有统计学意义(P<0.05);轻度活动组与重度活动组组间HLA-B27阳性率、抗环瓜氨酸肽(CCP)抗体阳性率比较(14.7%vs.22.9%、8.8%vs.12.0%),差异无统计学意义(P>0.05);重度活动组患者的平均ESR和C反应蛋白(CRP)值为9.4 mm/h、4.8 mg/L,均显著高于轻度活动组(1.6 mm/h、1.0 mg/L),差异均有统计学意义(P<0.05)。多因素Logistic回归发现PASI评分(OR=1.075,95%CI=0.930~1.243,P<0.05)与GUESS评分(OR=0.476,95%CI=1.057~2.453,P<0.05)是脊柱关节病型银屑病重度疾病活动度的独立影响因素。结论临床医师在早期评估银屑病关节炎患者时,应将PASI评分及GUESS评分作为整体评估脊柱关节病型银屑病关节炎的重要手段。

Objective To analyze the influencing factors of joint involvement in spondyloarthropathic psoriatic arthritis.To search for possible indicators of early detection of psoriatic arthritis.Methods A total of 358 patients with psoriatic arthritis treated in the Department of Rheumatology and Department of Dermatology,Beijing Friendship Hospital,Capital Medical University from September 2016 to February 2022 were retrospectively enrolled as the research subjects.The patients were divided into spondyloarthropathy psoriatic arthritis group(n=117)and peripheral arthropathy psoriatic arthritis group(n=241)according to the site of involvement.The patients with spondyloarthritis and psoriatic arthritis were grouped by disease activity,mild disease activity group(ASDAS<2.1,n=47),severe disease activity group(ASDAS≥2.1,n=70)according to the Ankylosing Spondylitis Disease Activity score(ASDAS).The correlation between imaging grade,Psoriasis Area and Severity Index(PASI)score,Glasgow Ultrasound Enthesment Scoring System(GUESS)score,autoantibodies,inflammatory markers and the severity of spondyloarthropathic psoriatic arthritis were analyzed.Results The rate of ocular involvement,HLA-B27 positive rate,erythrocyte sedimentation rate(ESR)and GUESS scores in the spondyloarthropathic psoriatic arthritis group were 14.5%,20.1%,(21.8±16.6)mm/h,(23.0±12.1)points,which were higher than thoe in the peripheral joint disease psoriatic arthritis group[6.2%,10.4%,(34.6±21.3)mm/h,(9.5±10.3)points],the differences were statistically significant(P<0.05).In the patients with spondyloarthropathy-type psoriatic arthritis,there was no significant difference in the CT grading of the sacroiliac joint between the mild activity group and the severe activity group(P>0.05);the PASI score and GUESS score of the severe activity group were(14.5±9.1)points,(12.8±9.6)points,which were higher than those of the mild activity group[(10.6±6.1)points and(2.2±3.4)points],the differences were statistically significant(P<0.05);there was no significant difference in the positive rate of HLA-B27 and anti-cyclic citrullinated peptide(CCP)antibody between the mild activity group and the severe activity group(14.7%vs.22.9%,8.8%vs.12.0%)(P>0.05);the average ESR and C reactive protein(CRP)values of the patients in the severe activity group were 9.4 mm/h,4.8 mg/L,which were significantly higher than those in the mild activity group(1.6 mm/h,1.0 mg/L),the differences were statistically significant(P<0.05).Multi-factor analysis shows that PASI score(OR=1.075,95%CI=0.930-1.243,P<0.05)and GUESS score(OR=0.476,95%CI=1.057-2.453,P<0.05)were independent influencing factors to severe disease activity of spondyloarthropathic psoriatic arthritis.Conclusion PASI score and GUESS score should be considered as an important means of evaluating spondyloarthropathic psoriatic arthritis patients.