Background Musculo-skeletal discomfort stands as the main clinical clue whenever psoriatic subjects are sent for rheumatological referral. Although skeletal dimorphisms (such as scoliosis, varus deformity of the knees, flat feet and so on) may play a role in the occurrence of painful symptoms, such issue is still poorly investigated.
Objectives Our aim was to investigate the influence of skeletal dimorphisms on musculo-skeletal discomfort in a series of patients with mild psoriasis subjects, in comparison to other factors.
Methods Among the psoriatic patients routinely followed-up in a dermatological clinic dedicated to psoriasis care, a cohort of 307 consecutively enrolled subjects was established for an epidemiological study. Patients on biological treatment and those unable to give informed consent were not eligible.
All candidates underwent a thorough rheumatological evaluation. Details about history of pain and skeletal dimorphisms were collected as well. Imaging and laboratory investigations were performed as needed. Diagnosis was established through expert opinion.
Results The 307 studied patients had mean age of 53.8 years (SD 16.3); 188 (61.2%) were males. Median psoriasis duration was 11 years (IQR 4.5-20), median PASI score was 3.1 (IQR 1.6-6.5). Systemic therapies were prescribed to 91 (29.6%) subjects.
Pain on examination was observed in 105 patients (34.2%). In this series, female gender, obesity and the presence of skeletal dimorphisms were all significantly related to pain on examination, while current smoking and age at the time of enrolment were not. In particular, the comparison between the several age classes composing this series (bounded by decades) did not highlight any statistically significant differences.
At univariate analysis, gender seemed to be more frequently related to the presence of musculo-skeletal pain, even among obese psoriatic subjects (P<0.05). A significantly higher proportion of skeletal dimorphisms was found in females as well (P<0.05).
The multivariable analysis, performed through unconditional logistic regression showed that skeletal dimorphisms remained an independent factor related to pain on examination as well as gender and obesity.
Conclusions In this study, skeletal dimorphisms were unexpectedly found to be related to musculo-skeletal discomfort, independently from obesity and gender.
The influence of that kind of disorders on psoriatic disease needs to be further investigated, in order to establish its significance on the natural history of this condition.
Disclosure of Interest None declared
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