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Clinical and epidemiological research
Extended report
Psoriasis and phenotype of patients with early inflammatory back pain
  1. Pascal Richette1,
  2. Florence Tubach2,
  3. Maxime Breban3,4,
  4. Manuelle Viguier5,
  5. Hervé Bachelez5,
  6. Thomas Bardin1,
  7. Maxime Dougados6
  1. 1AP-HP Hôpital Lariboisière, Pôle appareil locomoteur, Fédération de Rhumatologie, F-75010 Paris, France; Univ. Paris Diderot, Sorbonne Paris Cité, F-75205 Paris, France
  2. 2AP-HP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France; Univ. Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM CIE 801, Paris, France
  3. 3Rheumatology Dept., Hôpital Ambroise Paré, AP-HP, Univ. Versailles-Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France
  4. 4Dept. Immunology and Haematology, Institute Cochin, INSERM U1016, CNRS UMR 8104 and Univ. Paris-Descartes, Hôpital Cochin, 75014 Paris, France
  5. 5INSERM U781, Hôpital Necker and Department of Dermatology, AP-HP Hôpital Saint-Louis, Sorbonne Paris Cité Univ. Paris-Diderot, F-75205 Paris, France
  6. 6Rheumatology B Department, Cochin Hospital, Paris-Descartes University, Paris, France
  1. Correspondence to Pr Pascal Richett, Fédération de Rhumatologie, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75475 Paris cedex 10, France; pascal.richette{at}lrb.aphp.fr

Abstract

Background Psoriasis is an important clinical feature in spondyloarthritis. However, the influence of psoriasis on the clinical, functional and imaging features of patients with inflammatory back pain (IBP) related to spondyloarthritis is not known.

Objectives To determine the prevalence of psoriasis and its impact in patients with recent IBP suggestive of spondyloarthritis.

Methods The prevalence of psoriasis was determined in 692 patients (mean age 33.3±8.5 years, 53.8% female, 58.3% human leucocyte antigen B27 positive) included in the DESIR cohort. Demographic characteristics, imaging features and blood tests of patients with and without psoriasis were compared.

Results The prevalence of psoriasis was 16.6%. Patients with rather than without psoriasis more often presented with enthesitis (59.1% vs 47.5%; p=0.02) and had more active disease (BASDAI 4.8±1.8 vs 4.4±2.0; p=0.05) and poorer functional status (BASFI 3.6±2.2 vs 3.0±2.3; p=0.006; SF-36 (physical function) 61.9±24.4 vs 66.9±24.9; p=0.04). Patients with psoriasis showed higher levels of C-reactive protein (p=0.02), total cholesterol (p=0.01) and triglycerides (p=0.02). The two groups did not differ in structural changes as assessed by standard x-rays or MRI at the spinal and sacroiliac levels. However, ultrasonography of the Achilles tendon revealed psoriasis associated with bone erosions (p=0.0003) and abnormal vascularisation (p=0.04). Multivariate regression analysis revealed BASFI score (p=0.03), cholesterol level (p=0.02), dactylitis (p=0.0006) and family history of psoriasis (p<0.0001) as independent predictors of psoriasis.

Conclusions In patients with recent IBP suggestive of spondyloarthritis, psoriasis is associated with active axial disease and frequent concomitant enthesopathy and dactylitis.

https://doi.org/10.1136/annrheumdis-2012-201610

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    Footnotes

    • Competing interests None.

    • Funding This study received funding from the Programme Hospitalier de Recherche Clinique with the Assistance Publique – Hôpitaux de Paris as the sponsor. This work was also funded by the Association Rheumatisme et Travail, Rheumatology Department, Lariboisière Hospital, Paris, France.

    • Ethics approval This study was approved by the French Departmental Directorate of Health and Social Affairs (Directeur Départemental des Affaires Sanitaires et Sociales) and received approval from the ethics committees.

    • Patient Consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.