银屑病关节炎伴发疾病的临床特征分析

Clinical characteristics of psoriatic arthritis and the concomitant diseases

目的探讨银屑病和PsA的临床特征、伴发疾病及治疗现状的差异,为PsA的早期识别提供线索。方法纳入2020年11月至2021年5月于北京大学人民医院风湿免疫科和皮肤科就诊的225例银屑病和299例PsA患者,经患者知情同意后现场完成调查问卷。分析比较诊断PsA和银屑病患者之间的临床特征、伴发疾病、心理健康评估及治疗现状的差异。计数资料以例数(%)表示,组间比较采用χ^(2)检验;采用多因素Logistic回归进行危险因素分析;P<0.05为差异有统计学意义。结果指/趾炎[OR值(95%CI)=8.439(4.677,15.226),P<0.001]、臀部疼痛[OR值(95%CI)=3.442(1.829,6.480),P<0.001]、足跟痛[OR值(95%CI)=2.621(1.652,4.157),P<0.001]以及腰背痛[OR值(95%CI)=1.924(1.156,3.203),P=0.012]与PsA发生密切相关。PsA和银屑病患者最常伴发的3种疾病均为超重[43.1%(129/299)、29.3%(66/225)]、脂肪肝[(28.4%(85/299)、23.1%(52/225)]及高血压[24.1%(72/299、13.3%(30/225)]。进一步年龄分层分析显示,30~49岁的PsA患者发生骨质疏松的比例高于银屑病患者[30~39岁:12.5%(10/80)与1.5%(1/65),χ^(2)=6.14,P=0.013;40~49岁:19.2%(15/78)与2.0%(1/51),χ^(2)=8.46,P=0.004];40~49岁的PsA患者发生高血压的比例高于银屑病患者[7.0%(21/78)与2.7%(6/51),χ^(2)=4.99,P=0.026)];≥60岁PsA患者发生脂肪肝的比例高于银屑病患者[(46.0%(23/50)与29.1%(7/24),χ^(2)=4.99,P=0.025)],差异均具有统计学意义(P<0.05)。PsA中47.1%(141/299)患者有焦虑倾向、45.2%(135/299)伴有睡眠障碍、41.8%(125/299]有抑郁倾向,也分别高于银屑病患者[(44.4%(100/225)、40.0%(90/225)及36.9%(83/225)],但2组之间差异均无统计学意义(P>0.05)。结论PsA患者伴发慢性疾病和心身问题的比例较高,需要临床医生特别关注。伴有足跟痛、指/趾炎、腰背痛及臀部疼痛的银屑病患者,需要警惕PsA。

Objective To explore the differences on clinical characteristics,concomitant diseases and treatment status between psoriasis and psoriatic arthritis(PsA),and provide clues for the early diagnosis and treatment of PsA.Methods Data were collected by in-person interview of 225 patients with psoriasis and 299 patients with PSA who visited the department of rheumatology and Immunology and Department of Dermatology in People′s Hospital of Peking University from November 2020 to May 2021.After informed consent,the questionnaire was completed on site.The differences of clinical characteristics,concomitant diseases,mental health evaluation and treatment status between patients with arthritis(PsA)and patients with psoriasiswere analyzed and compared.Enumeration data were described by frequency.Chi square test was used to compare categorical variables.Multivariate Logistic regression analysis was used to determine the independent risk factors.P value of less than 0.05 was considered statistically significant.Results Dactylitis[OR(95%CI)=8.439(4.677,15.226),P<0.001],hip pain[OR(95%CI)=3.442(1.829,6.480),P<0.001],heel pain[OR(95%CI)=2.621(1.652,4.157),P<0.001]and low back pain[OR(95%CI)=1.924(1.156,3.203),P=0.012]may be closely related to the progression of PsA(P<0.05).The three most common concomitant diseases of patients with PsA and psoriasis both were overweight[43.1%(129/299)、29.3%(66/225)],fatty liver[(28.4%(85/299)、23.1%(52/225)]and hypertension[24.1%(72/299、13.3%(30/225)].The proportion of osteoporosis in PsA group at the age of 30-39 and 40-49 years old was significantly higher than those in psoriasis group(30-39 years old:12.5%(10/80)vs 1.5%(1/65),χ^(2)=6.14,P=0.013;40~49 years old:19.2%(15/78)vs 2.0%(1/51),χ^(2)=8.46,P=0.004].The proportion of hypertension in PsA group was also higher than that in psoriasis group at the age of 40~49 years old[7.0%(21/78)vs 2.7%(6/51),χ^(2)=4.99,P=0.026)].And the proportion of fatty liver in PsA group was also higher than that in psoriasis group at the age≥60 years old[(46.0%(23/50)vs 29.1(7/24),χ^(2)=4.99,P=0.025)].Among 299 PsA patients,47.1%(141/299)had anxiety tendency,45.2%(135/299)had sleep disorder and 41.8%(125/299)had depression tendency.Among 225 psoriasis patients,44.4%(100/225)had anxiety tendency,40%(90/225)had sleep disorder and 36.9%(83/225)had depression tendency,there was no significant difference in above-mentioned situations between the PsA and psoriasis patients(P>0.05).Conclusion More attention should be paid to the management of concomitant diseases and psychological intervention in patients with PsA.When psoriasis patients occur with heel pain,dactylitis,low back pain and hip pain,the risk of development into PsA should be considered.