Cristina Sarasqueta

Clinically Asymptomatic Axial Disease in Psoriatic Spondyloarthropathy. A Retrospective Study

Abstract: The aim of this study was to analyse retrospectively the prevalence and the clinical features of clinically asymptomatic axial involvement in patients with psoriasis and axial radiological features of spondyloarthropathy (PsSpA). We performed a cross-sectional study based on the clinical records of 70 patients, 44 men and 26 women, with a mean age of 48.7 þ 14.2 years. PsSpA was defined by the presence of radiographic sacroiliitis (SI) greater than or equal to grade 2, and/or any other typical radiological sign of spondylitis in patients with psoriasis. When the radiological signs were present in the absence of inflammatory back pain and/or buttock pain, patients were grouped as having asymptomatic axial disease. HLA-B27 was determined by serological methods in the 70 patients and in 82 healthy controls from our general population. Fourteen patients (20%), 11 with radiological SI, two with facet joint erosion-fusion and one with aseptic discitis, showed no evidence of symptomatic spinal disease. Twenty-nine patients (41%) showed cervical spine disease (CSD), but only 17 of them (58.6%) had pain and rigidity at this level, whereas 12 (41.4%) did not show clinical symptoms. CSD was associated with duration of arthritis (P= 0.043) and peripheral erosions (P = 0.037). HLA-B27 correlated well with bilateral SI (P = 0.002) and PsSpA (P<0.0004, RR 6.4), but showed no association with unilateral SI nor with syndesmophytes or asymptomatic disease. Univariate analysis demonstrated associations between symptomatic disease and longer duration of arthritis (P = 0.041) and higher IgM values (P = 0.05). There is a high prevalence of asymptomatic involvement in patients with PsSpA The significance of these asymptomatic changes is not known, but they probably represent a common characteristic of spondyloarthropathies rather than a specific feature associated with psoriasis.

HLA-C locus alleles may modulate the clinical expression of psoriatic arthritis.

The aim of the present study was to evaluate the relative contribution of human leukocyte antigen (HLA)-C locus alleles in determining the risk and the clinical expression of psoriatic arthritis (PsA). One hundred PsA patients were randomly selected and grouped into three disease subsets: oligoarthritis (n = 40), polyarthritis (n = 25) and spondylitis (n = 35). The HLA-C locus profile of this cohort was studied by methods based on molecular biology and was compared with that of 45 patients with psoriasis vulgaris and 177 healthy blood donors from the same ethnic origin. HLA-Cw*0602 was found associated with both psoriasis (odds ratio (OR) 6.2; 95% confidence interval (CI) 3.1 to 12.5; p < 0.0001) and PsA (OR 6.2; 95% CI 3.6 to 10.8; p < 0.0001); however, this allele was equally found among the PsA subsets. HLA-Cw6-positive patients showed a longer psoriasis-arthritis latency period (p = 0.012). HLA-Cw*0701 was found under-represented in PsA in comparison with controls (OR 0.5; 95% CI 0.3 to 0.9; p = 0.04), as was HLA-Cw*0802 (OR 0.3; 95% CI 0.08 to 1; p = 0.05). A positive association was found between psoriatic spondylitis and HLA-Cw*0702 (OR 5.0; 95% CI 1.4 to 25; p = 0.01). HLA-Cw*0602 seems to confer a general risk for psoriasis, but the presence of other HLA-C locus alleles may explain an additional arthritogenic risk. HLA-C alleles may modulate some aspects of the clinical expression of PsA, but these findings need confirmation.

Clinical expression, but not disease outcome, may vary according to age at disease onset in psoriatic spondylitis.

OBJECTIVES To investigate whether the clinical expression and disease outcome in psoriatic spondylitis (PsS) may vary according to age at disease onset. METHODS This study included 70 patients from a unique outpatient spondylitis clinic followed on a regular basis with a standard protocol. Patients were diagnosed with PsS according to ESSG criteria plus radiographic sacroiliitis (SI). Outcome parameters included: disease activity, functional evaluation, radiological damage, mobility restriction, and enthesitis score. Patients were divided into those with disease onset before 40 years (young-onset PsS) and those with onset over this age (late-onset PsS). Clinical features and outcome parameters were compared between groups. RESULTS There were 44 men and 26 women. Thirty-nine (M:F ratio 1.8) patients had disease onset before 40 years and 31 (M:F ratio 1.6) over this age. HLA-B27 correlated with PsS susceptibility (34% vs 7%, RR 6.4, p<0.0004), but it was found over-represented in young-onset PsS compared to late-onset cases (51% vs 13%, p=0.001). Young-onset cases tended to have a higher frequency of family history (26% vs 13%), bilateral SI (62% vs 29%, p=0.013), isolated axial pattern (31% vs 13%), and enthesitis (54% vs 29%, p=0.09). In late-onset PsS there was a higher frequency of unilateral SI (71% vs 38%, p=0.013), polyarthritis (45% vs 23%, p=0.022), and silent axial disease (32% vs 10%, p=0.022). Outcome parameters were similar between groups. CONCLUSIONS Clinical picture but not outcome parameters, varies according to age at disease onset in PsS. The correlation between HLA-B27 and young-onset PsS supports the notion that disease susceptibility and disease expression are not driven by the same gene in this entity.

Stratification by age of onset with 30 years as age limit is an effective means of identifying PSORS1-associated psoriasis in patients with psoriatic arthritis.

OBJECTIVES To determine which of the following is the best method to identify PSORS1-associated psoriasis in patients with psoriatic arthritis (PsA): age at disease onset or positive family history of disease. METHODS A total of 71 patients with PsA who met the CASPAR criteria were recruited on a randomized basis. The patients were stratified according to age at disease onset, with cutoff points at 25, 30, 35 and 40years of age. The alleles of locus Cw were analyzed by PCR-based methods, and their distribution was compared to that of 177 healthy blood donors. RESULTS HLA-Cw*0602-PSORS1- was associated with disease risk (56% vs. 18%) OR 5.8, 95%CI: 3.2-10.7, P=0.00001. A close relationship was established between this allele and onset of psoriasis under 30years of age (68% vs. 24%) OR 6.4, 95%CI: 2.3-18.2, P=0.0003. The relationship in turn lost significance above this age limit. An association was found between a family history of psoriasis and disease risk, though there was no specific cutoff point according to age at onset of the disease. Sixty-four percent of the subjects with positive family history were HLA-Cw*06 (+) compared to 44% of those without a family history, OR 2.3, 95% CI: 0.82-6.36, P=0.08. CONCLUSIONS In patients with PsA, the susceptibility effect of HLA-Cw*06 declines with increasing age of onset. Disease onset under or above 30years of age may contribute to differentiate type I vs. type II psoriasis in PsA populations, while the family history have a lesser contribution to such stratification.

Age at disease onset may help to further characterize the disease phenotype in psoriatic arthritis

OBJECTIVE To evaluate whether the age of disease presentation helps to better characterize the disease phenotype in PsA. METHODS Retrospective cohort study that included 205 consecutive patients fulfilling the CASPAR criteria for PsA. Study outcomes were assessed using univariate and multivariate analyses according to the age of onset of both skin and joint disease (cut off at 40years). RESULTS Early onset psoriasis (EOP) showed more extensive skin involvement (OR 2.3, P=0.011), axial pattern as disease onset (OR 4.6, P=0.009) and mixed pattern during evolution (OR 2.4, P=0.019), family history of both psoriasis (OR 3.1, P=0.003) and PsA (OR 4.0, P=0.021), higher prevalence of HLA-C*06 (OR 2.03, P=0.03) and HLA-B*27 (OR 2.7, P=0.02). Early onset arthritis (EOA) had more family history of PsA (OR 2.9, P=0.007), and HLA-B*27 positivity (OR 5.9, P<0.0001). Patients with late onset arthritis (LOA) were more likely to have DM (OR 4.0, P=0.009), hypertension (OR 2.5, P=0.004), dyslipidemia (OR 2.3, P=0.011), and obesity (OR 1.7, P=0.012). Late onset psoriasis (LOP) tended to have more obesity (OR 1.9, P=0.035), DM (OR 9.4, P<0.0001), hypertension (OR 4.1, P<0.0001), and ischemic heart disease during follow-up (OR 5.9, P=0.021). In multivariate analysis, LOP predicted DM development (OR 12.1, P=0.006). LOA was shown to be an independent risk factor for hypertension (OR 5.2, P=0.039). CONCLUSION Age at disease onset exerts a strong influence on several domains of disease phenotype in PsA. Therefore, this descriptor should be considered a good stratification option for epidemiological and genetic studies in PsA.

HLA-DR17 is associated with enthesitis in psoriatic arthritis

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 6 mai 2011

Spectrum of psoriatic spondyloarthropathy in a cohort of 100 Spanish patients

In their initial work, Moll and Wright recognised five patterns of psoriatic arthritis (PsA)—namely, distal joint disease, oligoarthritis, polyarthritis, arthritis mutilans, and spondylitis.1 Although psoriatic spondyloarthropathy was recognised as a specific pattern of PsA, it has become clear that the presence of isolated spondyloarthropathy (SpA) in PsA is unusual, and in most cases, it occurs with peripheral arthritis.2,3 We undertook the present work to analyse the clinical features of our patients with psoriatic SpA and to compare the different subgroups included within the psoriatic SpA spectrum. One hundred patients with psoriatic SpA, defined in accordance with the European Spondyloarthropathy Study Group (ESSG) criteria,4 were consecutively recruited and their clinical records were analysed in this retrospective cross sectional study. All patients were evaluated according to a standard protocol, and their functional ability was assessed using the Health Assessment Questionnaire-Specific for SpA (HAQ-S).5 We included patients with isolated axial involvement, as well as those with axial plus peripheral disease. The study group was divided according to the articular patterns seen during …

Prevalence and predictors of cervical involvement in psoriatic spondyloarthropathy.

Cervical spondylitis has been reported in 35%–75% of patients with psoriatic arthritis (PsA), and this likely represents the highest frequency of cervical involvement among the spondyloarthropathies. Although 2 patterns of cervical spondylitis have been recognized in PsA, this may reflect a lack of a satisfactory definition of cervical spondylitis in PsA. In a retrospective cross-sectional study, we analyzed the clinical records of 100 consecutive patients recruited at a single university hospital who were diagnosed as having psoriatic spondyloarthropathy on the basis of radiographic sacroiliitis. All patients were involved in a clinicoradiologic study of the cervical column to evaluate the frequency and the predictors of this involvement. Forty-one patients showed radiographic signs of cervical involvement and 24 of them (58.5%) complained of cervical pain and stiffness, whereas 17 (41.5%) had radiologic disease with no symptoms. Arthritis duration (odds ratio, 1.08; 95% confidence interval, 0.99–1.19;p < 0.05) and peripheral erosive disease (odds ratio, 2.5; 95% confidence interval, 1.91–6.92;p < 0.05) were found to be associated with cervical spondylitis development. This study showed a high frequency of cervical spondylitis among patients with psoriatic spondyloarthropathy, confirming previous reports. Although none of our patients developed neurologic sequelae, this report also showed that clinical symptoms of cervical pain and stiffness are not a universal predictor of involvement of the cervical spine, and therefore, patients with PsA with longer disease duration and erosive disease should be screened radiologically to detect those cervical lesions (i.e., atlantoaxial subluxation) with potential catastrophic complications.