Background Different clinical domains contribute to the severity of PsA. These include peripheral arthritis, spinal disease, Enthesitis, Dactylitis in addition to skin disease. The severity of these domains can be clinically assessed individually 1. As a disease with a worlwide dictribution, reports from all areas would aid to the production of a more generalizable management guidelines.
Objectives Idetify the clinical charachteristics of PsA among Egyptian adults.
Methods We conducted an observational cohort study on 56 PsA patients with established diagnosis of psoriasis by Dermatologist. History, clinical examination, calculation of Psoriasis severity using PASI &BSA and US examination were obtained for all patients. Severity of each clinical was assessed according to ref. (2).
Results The mean age of PsA onset was 33.86±7.37 years and ranged from 13- 43 years old, and its mean duration was 2.9±0.9, ranged from 1-5 years. 75% of the patients had undiagnosed PsA.
Predominant SpA phenotype was the most common according to Moll & Wright, 1973 classification, it was found 20 cases out of 56 (35.7%). Both Predominant DIP and Symmetric polyarthritis were found in 16 out of 56 (28.6%). The least common was Asymmetric Oligoarthritis 4 out of 56 (7.1%). No arthritis mutilans were reported among our patients.
The predominant site affected according to ASAS classification and CASPAR criteria was the Joint (50% of patients), followed by entheseal (14.3%) then spinal (7.14%); The rest of patients had various overlap of those main three sites. Nail changes was present in 20 PsA patients, 75% of them in the Predominant DIP and 25% in Symmetric polyarthritis subtypes. Tender entheses was found in 160 out of the 896 (17.85%) examined sites. The Plantar fascia, Quadriceps tendon insertion and Common Flexor origin are the most common tender sites in the lower abd upper limbs respectively. Grey scale Ultrasound detected subclinical enthesopathy in 284 out of 896 (31.7%) sites. Mean GUESS score was 6.96±4.65.
The subclinical enthesopathy detected by US were more common in the asymmetric oligoarthritis subtype 28 site out of 64 (43.75%), and the predominant SpA subtype 132 site out of 320 (41.25%) considered as “SpA like”, than Symmetric
Polyarthritis 72 out of 256 (28.1%) and predominant DIP 52 out of 256 (20.3%) “RA like”.
Conclusions Our observations highlight the heterogeneity between the old Moll& Wright phenotypic classification and the recent CASPAR and ASAS classifications for SpA (especially PsA), which present (in our study) more commonly with non-axial affection. However the recent trend to classify and identify non-radiographic axial SpA may close that gap.
Our results showed that entheses in the lower limb other than plantar fascia and Achilles tendon (Supra patellar, infra patellar and tibial tuberosity) should be considered at least in practice especially in PsA as the three examined entheses around the knee showed same degree of significance and specificity with PsA.
It worth to mention that 75% of PsA was not previously diagnosed at time we examined them, which reflect delayed proper treatment for their arthritis.
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Mease, P.J. (2011): Psoriatic arthritis: update on pathophysiology, assessment and management. Ann Rheum Dis, 70(Suppl 1):77–84.
Disclosure of Interest None declared