Распространенность псориатического артрита и коморбидных заболеваний у больных тяжелым псориазом: данные ретроспективного анализа госпитальной когорты

Objective: to study the prevalence of psoriatic arthritis (PsA) and comorbidities in a hospital cohort of patients with severe psoriasis (PsO).Patients and methods. Case history data were retrospectively analyzed in 592 patients with PsO (348 men and 244 women; mean age, 49.2±0.6 years; mean PsO duration, 11.8±0.6 years; mean Psoriasis Area and Severity Index (PASI), 49.4±0.5 scores) who had been treated at the Branch of the V.G. Korolenko Clinic, Moscow Research and Practical Center of Dermatovenereology and Cosmetology, in 2010 to 2011. The diagnosis of comorbidities was confirmed by medical specialists in accordance with the ICD-10 code; the rate and pattern (%) of comorbidities were analyzed.Results. Out of the 592 patients with PsO, 503 (85.1%) were found to have comorbidities. Diseases of the cardiovascular system (CVS)(I00–I199) were recorded in the majority (61.6%) of the patients. PsA (L40.5, M07.0–M07.3) was detected in 39.4% of the examinees. Other diseases of the skeletomuscular system unassociated with psoriasis (M00–M99) were present in 27.6% of the patients. Diseases of the gastrointestinal tract (GIT) and hepatobiliary system (K00–K93, B15–B19) were found in 47.5% of the patients. Endocrine diseases, nutritional and metabolic disorders (E00–E90), particularly diabetes mellitus, thyroid diseases, and obesity, were diagnosed in 12.2, 24, and 88% of the patients with PsO, respectively. 13.9% of the patients with PsO had urinary tract diseases, among them there was chronic pyelonephritis (N20), kidney cysts (N28.1), urolithiasis (Q61), prostate diseases (N11) in 73, 71, 47, and 27% of cases, respectively.Conclusion. Most patients with severe PsO were observed to have comorbidity, primarily diseases of the locomotor apparatus, CVS, and GIT. PsA was recorded in more than one third of patients. Comorbidity was identified in 36% of the patients with PsO.Цель исследования – изучить распространенность псориатического артрита (ПсА) и коморбидных заболеваний у госпитальной когорты больных с тяжелым псориазом (Пс).Пациенты и методы. Выполнен ретроспективный анализ данных историй болезней 592 больных Пс (348 мужчин и 244 женщин, средний возраст – 49,2±0,6 года, средняя длительность Пс – 11,8±0,6 года, средний PASI – 49,4±0,5 балла), находившихся на стационарном лечении в филиале «Клиника им. В.Г. Короленко» Московского научно-практического центра дерматовенерологии и косметологии с 2010 по 2011 г. Диагноз сопутствующих заболеваний подтверждали врачи-специалисты в соответствии с кодом по МКБ-10; анализировали частоту и структуру (в %) коморбидных заболеваний.Результаты. У 503 (85,1%) из 592 больных Пс выявлены сопутствующие заболевания. У большинства пациентов (61,6%) зарегистрированы сердечно-сосудистые заболевания (ССЗ; I00–I199). ПсА выявлен у 39,4% обследованных (L40.5, M07.0–M07.3). Другие заболевания костно-мышечной системы, не связанные с псориазом (M00–M99), имелись у 27,6% пациентов. Заболевания желудочно-кишечного тракта (ЖКТ) и гепатобилиарной системы (К00–К93, В15–В19) выявлены у 47,5% больных. Заболевания эндокринной системы, расстройства питания, нарушения обмена веществ (Е00–Е90), в частности сахарный диабет, болезни щитовидной железы, ожирение, диагностированы соответственно у 12,2, 24 и 88% больных Пс. Заболевания мочеполового тракта имелись у 13,9% пациентов с Пс, из них хронический пиелонефрит (N20), кисты почек (N28.1), мочекаменная болезнь (Q61), заболевания предстательной железы (N11) отмечены в 73; 71; 47 и 27% случаев соответственно.Выводы. У большинства пациентов с тяжелым Пс наблюдается коморбидная патология, в первую очередь заболевания опорно-двигательного аппарата, ССЗ и ЖКТ. ПсА зарегистрирован более чем у трети больных. У 36% больных Пс выявлена коморбидная патология

Multiplicity of comorbidities in patients with severe psoriasis

Rationale: Severe treatment-resistant psoriasis and comorbidities are on the rise.Aim: To evaluate the prevalence of comorbidities in a  hospital-based cohort of patients with severe psoriases.Materials and methods: We performed a  retrospective analysis of medical files of 890  patients with moderate-to-severe plaque psoriasis (PASI > 10) treated in a  hospital from 2010 to 2015 (men, 516 [58%], women, 374 [42%]; mean age 51.9 ± 11.6 years; mean PASI, 44.3 ± 7.8  scores).Results: Comorbidities were found in 61% (543 / 890) of the patients with severe psoriasis, with cardiovascular disorders ranking first (59%, or 516 / 890) and gastrointestinal and hepatobiliary disorders ranking second (46,4%, or 413 / 890). Psoriatic arthritis was diagnosed in 34% (303 / 890) of the patients and other disorders of the musculoskeletal system unrelated to psoriasis in 19.8% (176 / 890). The proportion of diabetes was 15.4% (137 / 890).Conclusion: Psoriasis has a high rate of comorbidities, in particular of cardiovascular disorders. It significantly deteriorates the course of psoriasis and its response to therapy, and in some cases may reduce the possibility of adequate anti-psoriatic treatment due to contraindications

THE PATTERN OF CARDIOVASCULAR COMORBIDITY IN PATIENTS WITH SEVERE FORMS OF PSORIASIS: DATA OF RETROSPECTIVE ANALYSIS OF A HOSPITAL COHORT

Psoriasis (Ps) and psoriatic arthritis (PsA) are, in addition to skin and osteoarticular lesions, accompanied by a variety of comorbidities, primarily cardiovascular diseases (CVDs), which contributes to shorter life expectancy by on an average of 5–7 years. There are scarce data on the prevalence and pattern of CVDs in a Russian cohort of patients with severe forms of Ps and PsA. Obtaining such information can contribute to the elaboration of programs for screening and prevention of CVDs in this patient group.Objective: to study the prevalence and pattern of CVDs in a hospital cohort of patients with severe forms of Ps and PsA.Subjects and methods. Medical records were retrospectively analyzed in 890 patients with severe forms of Ps (mean age, 51.9±11.6 years; mean Ps duration, 11.6±0.6 years); who had been treated at the Branch of the V.G. Korolenko Clinic, Moscow Research and Practical Center of Dermatovenereology and Cosmetology, in 2010 to 2015. The Psoriasis Area and Severity Index (PASI) averaged 49.4±0.5. The frequency of PsA was assessed by the code L40.5; that of SVDs was determined by the registered diagnoses in accordance with the codes of the International Classification of Diseases, 10th edition (ICD-10): hypertension (ICD-10 code I10–I15), coronary heart disease (CHD) (I20–I25), atherosclerosis (I70), and cerebrovascular disorders (I65–I66).Results and discussion. PsA was identified in 303 (34%) patients. There were a total of 516 (59%) patients with CVDs. Hypertension, CHD, atherosclerosis, and cerebrovascular disorders were more frequently recorded in patients with PsA than in those with PsA without arthritis.Conclusion. CVDs are recorded in more than half of the hospital cohort patients with severe forms of Ps. CVDs are more frequently recorded in PsA than in Ps without arthritis. Hypertension among the SVDs is a leader in its frequency in both groups; more than half of the patients were found to have CHD and atherosclerosis; cerebrovascular disorders were less common

Prevalence of psoriatic arthritis and comorbidities in patients with severe psoriasis: Data of a retrospective analysis of a hospital cohort

Objective: to study the prevalence of psoriatic arthritis (PsA) and comorbidities in a hospital cohort of patients with severe psoriasis (PsO).Patients and methods. Case history data were retrospectively analyzed in 592 patients with PsO (348 men and 244 women; mean age, 49.2±0.6 years; mean PsO duration, 11.8±0.6 years; mean Psoriasis Area and Severity Index (PASI), 49.4±0.5 scores) who had been treated at the Branch of the V.G. Korolenko Clinic, Moscow Research and Practical Center of Dermatovenereology and Cosmetology, in 2010 to 2011. The diagnosis of comorbidities was confirmed by medical specialists in accordance with the ICD-10 code; the rate and pattern (%) of comorbidities were analyzed.Results. Out of the 592 patients with PsO, 503 (85.1%) were found to have comorbidities. Diseases of the cardiovascular system (CVS)(I00–I199) were recorded in the majority (61.6%) of the patients. PsA (L40.5, M07.0–M07.3) was detected in 39.4% of the examinees. Other diseases of the skeletomuscular system unassociated with psoriasis (M00–M99) were present in 27.6% of the patients. Diseases of the gastrointestinal tract (GIT) and hepatobiliary system (K00–K93, B15–B19) were found in 47.5% of the patients. Endocrine diseases, nutritional and metabolic disorders (E00–E90), particularly diabetes mellitus, thyroid diseases, and obesity, were diagnosed in 12.2, 24, and 88% of the patients with PsO, respectively. 13.9% of the patients with PsO had urinary tract diseases, among them there was chronic pyelonephritis (N20), kidney cysts (N28.1), urolithiasis (Q61), prostate diseases (N11) in 73, 71, 47, and 27% of cases, respectively.Conclusion. Most patients with severe PsO were observed to have comorbidity, primarily diseases of the locomotor apparatus, CVS, and GIT. PsA was recorded in more than one third of patients. Comorbidity was identified in 36% of the patients with PsO

OSTEOARTICULAR INJURY IN PSORIATIC PATIENTS ACCORDING TO THE DATA OF PEST (PSORIASIS EPIDEMIOLOGY SCREENING TOOL) QUESTIONNAIRE AND RHEUMATOLOGICAL CLINICOINSTRUMENTAL EXAMINATION

Objective: to estimate the prevalence of psoriatic arthritis (PsA) and the pattern of osteoarticular injury in psoriatic patients according to the data of the PEST (Psoriasis Epidemiology Screening Tool) questionnaire.Subjects and methods. The trial included 80 psoriatic patients who had sought for dermatological and rheumatological advice (35 men and 45 women); mean age 43.06±1.71 years; psoriatic skin damage area (PSDA) 9.83±2.63%; and psoriasis area severity index (PASI) 12.05±3.23; dermatology life quality index (DQLI) 8.57±0.94. Answers to 6 questions about nail psoriasis in the PEST questionnaire were rated; each positive answer corresponded to 1; PEST ≥3 or <3 is indicative of the presence or absence of psoriasis, respectively. All patients, irrespectively of PEST value, were examined by a rheumatologist and underwent a standard clinicoinstrumental examination. The CASPAR criteria were considered to be a gold standard of PsA diagnosis.Results. 53 (66.2%) patients had PEST≥3; the CASPAR criteria confirmed PsA in 40 (75.4%) of them. 27 (33.8%) patients had PEST<3; in 13 (48%) of them, fulfilled CASPAR criteria. PsA was first diagnosed in 30 (56.6%) of the 53 patients. Thus, PsA was identified in 53 (66.2%) of the 80 patients; another rheumatic disease (RD), such as dermatomyositis, rheumatic polymyalgia, osteoarthritis, ankylosing spondylitis, reactive arthritis, rheumatoid arthritis (RA), gout, etc., was found in 10 (12.5%); a concurrence of RDs (RA and gout) in 3 (3.7%); RD was absent in 14 (17.5%) cases. The disease duration was <1 year in 17 (34%) of the 53 patients with PsA, 1 to 2 years in 16 (32%), 2 to 3 years in 11 (22%), and ≥3 years in 9 (18%). Nail psoriasis was detected in 55 (70%) patients. It was found in 38 (71.7%) patients with PsA and in 17 without this disease. In patients with PsA, PSDA averaged 7.23±2.24%; PASI 11.69±1.94; DQLI 7.71±0.17, respectively; in those without PsA 11.44±2.78%, 14.94±4.29, and 8.96±1.74, respectively. No significant differences of these parameters were found.Conclusion. Thus, in psoriasis, there may be any RD, chiefly PsA with common nail involvement. The PEST questionnaire reveals PsA at its early stage in the majority of cases; however, its isolated use is not sufficient to establish accurate diagnosis and rheumatologic clinicoinstrumental examination is necessary

Especially diseases of the cardiovascular system in patients with severe and medium-severe plaque psoriasis

Background. Psoriasis is a chronic inflammatory disease that associated with a decrease in life expectancy mostly due to cardiovascular disease. But prevalence of cardiovascular comorbidity in psoriasis patients has limited data. Objectives. To compare the prevalence of cardiovascular comorbidity in a hospital-treated cohort patients with severe psoriasis and psoriatic arthritis. Methods. 890 patients (M. - 516/F. - 347) with severe plaque psoriasis mean duration 25.7 ± 16.6 years, mean age of patients were 51.9 ± 11.6 years accordingly were included. Psoriasis patients with cardiovascular disease, including coronary heart disease, arterial hypertension, atherosclerosis and cerebrovascular accident were identify in the hospital Database reporting and coding by International Statistical Classification of Disease and Related Health Problems (ICD-10) between 2010-2015 years. M ± m, t-test, (%) were calculated. All p < 0.05 were considered to indicate statistical significance. Results. Male and Female patients were at the same age. 303 out of 890 patients (34.0%) had psoriatic arthritis, 587 out of 890 patients (66.0%) had severe plaque psoriasis with mean PASI 49.4 ± 0.5. 516 out of 890 patients (59.0%) had cardiovascular disease. Cardiovascular disease coding as I 00-I 99 were found significantly often in patients with psoriatic arthritis compare to patients with psoriasis - in 206 out of 303 patients (68.2%) and in 310 out of 587 patients (52.8%) accordingly (p < 0.05). Arterial hypertension coding as I 10-I 15 were found in significantly more cases in patients with psoriatic arthritis compare to patients with psoriasis - in 206 out of 303 patients (68.2%) and in 310 out of 587 patients (52.8%) accordingly (p < 0.05). Coronary heart disease and atherosclerosis coding as I 70 were found in significantly more cases in patients with psoriatic arthritis compare to patients with psoriasis - in 129 out of 303 patients (42.7%) and in 205 out of 587 patients (34.9%) accordingly (p < 0.05). Cerebrovascular accident coding as I 65 - I 66 were found in significantly more cases in patients with psoriatic arthritis compare to patients with psoriasis - in 50 out of 303 patients (16.6%) and in 64 out of 587 patients (10.9%) accordingly. Conclusions. Psoriatic arthritis and cardiovascular comorbidities are common for hospital-treated cohort patients. Patients with severe plaque psoriasis and psoriatic arthritis tend to suffer from cardiovascular disease and arterial hypertension