Background Spondylarthritis is a rheumatic disease with axial and peripheral symptoms. It is divided into 6 groups; Ankylosing spondylitis, Psoriatic arthritis, Arthritis associated with inflammatory bowel disease, Reactive arthritis, Unspecified spondyloarthritis and Juvenile spondyloarthritis. There is an ongoing discussion whether it is one disease or separate diseases. The prevalence of spondylarthritis have been reported ranging from 0,3% to 1,9% in different populations. The proportion with concommitant psoriasis varies from 13% to 60%. Psoriatic arthritis, especially with predominantly periphera symptomsl is often seen as a separate entity, and will often not be included in the spondyloarthritis cohorts. We do not know if spondylarthritis with concommitant psoriasis is different from spondylarthritis without psoriasis.
Objectives To compare spondylarthritis patients from Rana, Norway with and without psoriasis. Are they different in age, gender, body mass index, inflammation, disease activity, physical function, proportion of synovitis, inflammatory backpain, radiological sacroileitis, sacroileitis on mri, axial disease only, combined peripheral and axial disease, inflammatory bowel disease, acute uveitis, reactive arthritis and HLAB27 positivity? Do the data support that psoriatic arthritis is a separate entity or is it just spondylarthritis with psoriasis?
Methods Patients with spondylarthritis, inclusive of psoriatic arthritis were recruited from hospital registers, family doctors and by advertisement in local newspaper. Clinical data, Crp HLAB27 were collected, x-ray and mri of SI-joint was performed if the patient had inflammatory backpain. If they fulfilled the ESSG-critera for Spondylarthritis they were included. The first degree relatives of the included patients were contacted and asked for symptoms of synovitis or inflammatory bacppain by questionnaire. Symptomatic relatives were investigated, and included if they fulfilled the ESSG-critera. 387 spondylarthrits patients were included.
162 patients with psoriasis were compared to 225 patients without psoriasis. 273 patients had mriof SI-joints
Statistic testing with SPSS Chi square test or Students T-test
Results Spondylarthritis patients with psoriasis are approximately 4 years older, they are more likely to have synovitis, axial disease only and combined peripheral and axial disease. They were less likely to have inflammatory backpain, radiological sacroileitis and HLAB27 positivity. There was no difference in gender,body mass index, inflammatory bowel disease, reactive arthritis, acute uveitis, Crp, disease activity and physical function. They were as likely to have sacroileitis (ASAS-definition) on mri.
Conclusions Spondylarthritis with and without concomitant psoriasis have many similarities, but also differences. A possible explanation can be that concommittant psoriasis modifies spondylarthritis.
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Reveille JD, Weisman MH. The epidemiology of back pain, axial spondyloarthritis and HLA-B27 in the United States. Am J Med Sci. 2013 Jun;345(6):431-6. Review. PubMed PMID: 23841117.
Disclosure of Interest : None declared
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