Impact of comorbidities on the clinical and ultrasound features of psoriatic arthritis

Abstract

Summary. Objectives. The objective was to evaluate the relationship of comorbid pathology with the clinical and ultrasound characteristics of the evolution of psoriatic arthritis in order to optimize the management. Material and methods. In order to achieve the purpose and objectives of the study, a group of 92 patients with psoriatic arthritis was selected, established in accordance with the CASPAR diagnostic criteria (2006). The patients were treated in the rheumatology and arthrology departments of the Timofei Moşneaga Republican Clinical Hospital and of the Saint Trinity Municipal Clinical Hospital in Chisinau during 2017-2020. A type 1 cohort study is planned (prospective study with retrospective components). Results. Expression at the time of examination of the history data was observed in 54 (58,7%), clinical enthesitis was observed in 47 (51.1%) patients. During the clinical examination of patients, it was found that the frequency of TJC/14 was 11.3% (145/1288), SJC/14 – 4.5% (58/1288), which was 40% (58/145) among all painful joints. During clinical examination, it was found that the TJC of the upper limbs (74/736, 10.1%) and lower (71/552, 12.9%) do not differ significantly (χ2 = 2.489, p = 0.115). At the same time, the SJC of the lower limbs (43/552, 7.8%) was significantly higher than the upper one (15/736, 2.04%) (χ2 = 24.267, p < 0.001). According to ultrasound data, the number of joints examined was 228/1288 (17.7%), number of inflamed entheses – 90/1288 (6.9%), which was 39.5% among the detected synovitis (90/228). The number of enthesitis were 661/4968 (13.3%), of which 19.4% (128/661) of the entheses were vascularized. Conclusions. According to ultrasound data, the frequency of detection of enthesitis and synovitis was significantly higher than during the clinical examination (p < 0.01). For its part, the psoriatic arthritis activity index (DAPSA) did not correlate with inflammatory changes detected during extensive ultrasound of large joints and entheses according to the “gray scale” and the use of Power-Doppler (p > 0.05). On the other hand, vascularization in the entheses is an index of activity independent of age and activity of psoriatic arthritis and psoriasis (p > 0.05), and it is a sign of active inflammation which correlates with laboratory markers of inflammation (hs-CRP, p < 0.05; ESR, p < 0.01).