对Moll Wright关节病型银屑病诊断标准的初步评价

目的:评价关节病型银屑病"Moll和Wright"诊断标准的敏感性与特异性.方法:对伴脊柱关节症状和/或体征的银屑病患者按Moll和Wright标准诊断关节病型银屑病,并与"金标准"诊断结果比较.结果:79例银屑病患者纳入研究,按Moll和Wright标准诊断关节病型银屑病43例;按"金标准"确诊61例.Moll和Wright标准的敏感性为67%,特异性为89%.结论:Moll和Wright标准敏感性和特异性较差,今后需对包括影像学指标在内的新的诊断标准进行研究.     

关节病性银屑病61例临床与影像学分析

目的 探讨关节病性银屑病的临床与影像学特征,为制订敏感性高、特异性好的诊断与分型标准提供依据。方法 采用横断面-回顾性研究的方式,详细分析61例确诊的关节病性银屑病患者就诊当时的临床和影像学特征以及其发病特征和演变规律,并与传统标准描述的特征进行比较。结果 横断面研究发现,关节病性银屑病临床与影像学表现多样,传统标准描述的5种临床特征：远端指（趾）关节炎38例,非对称性少数关节炎5例,对称性多关节炎33例,残毁性关节炎4例,强直性脊柱炎12例,各型之间互有重叠;传统标准未描述的临床特征：外周附着点炎19例（31%）,未分化脊柱关节病（uSpA）17例（28%）,颞颌关节炎5例、胸锁关节炎1例。传统标准描述的影像学特征：骨质吸收--笔帽状畸形6例,指端削尖样改变6例,韧带骨赘竹节样改变5例,骶髂关节炎Ⅲ-Ⅳ级8例;传统标准未描述的影像学特征包括：绒毛状骨膜炎19例,边界不清的骨质增生12例,骨质侵蚀25例,局限性非对称性韧带骨赘8例,骶髂关节炎Ⅱ-Ⅲ级8例。回顾性研究发现,关节病性银屑病发病特征亦多样化,且呈现进展性病程。结论 关节病性银屑病临床与影像学特征及其发病特征表现多样,演变规律复杂,传统的标准仅能涵盖部分临床和影像学特征,不能满足早期诊断与合理分型的需要,应探讨新的诊断与分型标准。     

CASPAR标准在关节病性银屑病中的初步应用与评估

关节病性银屑病(PsA)是一种常见自身免疫性疾病,表现为与银屑病相关的进行性、致残性及炎性关节病,其中20%~50%的患者会出现进行性破坏性关节炎,造成关节畸形、残毁,严重影响了患者的社会交往和生活质量~([1-3])。长期以来,PsA的诊断一直沿用1973年Moll和Wright的分类标准~([4-6]),敏感度和特异度不高,不能反映疾病的进展情况,按照这一分类标准确诊PsA时患     

银屑病关节炎的临床特征和治疗

银屑病关节炎作为一种独立疾病的概念已被大家广泛接受,目前归为血清类风湿因子阴性脊柱关节病。此病并不罕见,可发生于7%-40%的银屑病患者中^[1]。关节炎严重影响患者的生活质量,早期诊断并及时治疗能延缓或阻止关节损害。为此,我们分析38例银屑病关节炎患者的临床、实验室及影象学特点。一、临床资料1.病例选择:全部病例为2000年1月至2003年12月本院门诊或住院患者,共38例。均详细询问病史,体检,检测血常规、血沉、C反应蛋白、类风湿因子(RF)、HLA-B27及X线检查。2.诊断标准:参考Moll和Wright的银屑病关节炎分类标准^[2]:①至少有1个关节炎并持续3个月以上,②至少有银屑病皮损     

基于广义估计方程的甲银屑病皮肤镜临床分型的模式研究

目的 探讨甲银屑病的皮肤镜表现与临床分型的相关性,为临床诊治甲银屑病提供现实依据。方法 选择2019年8月—2021年8月于河北中石油中心医院收治的甲银屑病患者48例为甲银屑病组,且经皮肤镜观察,另选择同期100例健康体检者为健康对照组,记录两组一般资料。结果 两组患者在年龄、性别、糖尿病史、高血压史、药物过敏史、吸烟史、饮酒史、体温、体质指数（BMI）等方面的比较,差异无统计学意义（P> 0.05）。甲银屑病患者根据病甲皮肤镜图像特征划分,甲板增厚12例、点蚀征8例、甲剥离7例、油滴征6例、裂片型出血4例、甲变色6例、甲床毛细血管扩张5例;按照临床分型的特征划分,寻常性银屑病18例、红皮病性银屑病12例、脓疱性银屑病11例、关节病性银屑病7例。皮肤镜诊断与临床分型结果显示,甲板增厚、点蚀征、甲剥离、油滴征、裂片型出血、甲变色、甲床毛细血管扩张在4种临床分型方面的比较,差异具有统计学意义（P <0.05）。广义估计方程模型显示,皮肤镜诊断对临床分型有显著影响,即皮肤镜诊断每增加或减少1例,4种银屑病临床各分型相应分别增加或减少,截距分别为4.986、3.552、2.362、...     

山东地区汉族关节病型银屑病与HLA—DRB1、DQB1的相关性研究

目的：探讨mA—DRB1、DQB1位点基因与关节病型银屑病的相关性。方法：用序列特异性引物一聚合酶链反应（PCR—SSP）方法，对41例关节病型银屑病患者进行了HLA—DRB1、DQB1等位基因的分型，并分析了上述基因在各组中的分布。结果：关节病型银屑病患者组DRB1＊07、DQB1＊0201频率较正常对照组增高；多关节炎型银屑病患者组DRB1＊07、DQB1＊0201以及DRB1＊04基因频率比正常对照组显著增高。结论：HLA—DRB1＊07、DQB1＊0201可能是山东地区汉族关节病型银屑病的遗传标志；具有银屑病易感基因的个体，携带HLA—DRB1＊04基因时，患多关节炎型银屑病的危险性可能增加。     

关节病型银屑病26例分析

关节病型银屑病(PA),又称银屑病性关节炎,根据流行病学、临床、放射学和血清学确认它为一种独特的关节病[1]。为探讨其临床特点、治疗反应与预后的关系,现将我院近年来收治的26例PA患者和部分随访病例的临床资料作一回顾性分析,现报道如下。一、一般资料26例均为首次住院患者。其中男19例,女7例,男女之比为2.7:1。发病年龄15～63岁,平均37.1岁,30～50岁发病者17例,占65%。均未提及有银屑病及关节病的家族史。二、临床表现1.发病方式:皮损先发者21例,从皮损至关节症状出现的间隔时间不定,<1年者3例,>10年者7例,最长达21年。皮损和关节症状…     

指间关节病性银屑病14例临床分析

关节病性银屑病(PsA)又称银屑病性关节炎,远端指间关节受累、不对称性关节炎、附着点炎及指(趾)炎是PsA的经典表现[1].Moll-Wright分类标准将本病分为5种类型:①远端指(趾)间关节炎型(DIP);②非对称性少关节炎型(AO);③对称性多关节炎型(SP);④残毁性关节炎型(AM);⑤脊椎关节病型(SPON)[2].为探讨特定类型PsA的临床特点,本文对首发类型为DIP型PsA患者的临床资料进行归纳总结.     

关节病性银屑病52例临床分析

目的：探讨关节病性银屑病的临床特点。方法：对52例关节病性银屑病患者的临床资料进行回顾性分析。结果：本组病例平均发病年龄31岁，男：女为3．7：1。以皮损为首发者45例，占87％；皮损和关节症状同时出现者2例，占4％；以关节炎为首发者5例，占10％。皮损类型为寻常性32例，占62％；红皮病性9例，占17％；急性泛发性脓疱性11例，占21％。关节炎分类为远端指(趾)关节炎23例，占44％；类风湿性关节炎样型11例，占21％；非对称性少数大关节炎10例，占19％，主要为强直性脊柱炎8例，占15％。接受x线检查的39例中，30例阳性，占77％。结论：本病男性发病多于女性．各型银屑病皮损都可伴发关节炎病变。非对称性多发性关节炎和远端指(趾)关节易受累是本病的特点。小剂量糖皮质激素、雷公藤多苷、甲氨蝶呤、非甾体类抗炎药、秋水仙碱、柳氮磺胺吡啶、阿维A等合理联合应用可取得较好疗效。     

寻常性与关节病性银屑病发病机制的差异

关节病性银屑病和寻常性银屑病为银屑病的两个临床亚型,其临床表现上的差异可能与遗传、免疫及环境因素等相关.HLA-B、MICA＊00801纯合子、CARD15、TNF＊-857T、TRAF3IP2及IL-13等基因在关节病性银屑病患者中的频率较高;HLA-Cw＊06、MICA＊016、LCE等基因在寻常性银屑病患者中的频率较高.CD8＋T细胞、TNF-α及IL-22在关节病性银屑病的关节损伤中起重要作用;CD4＋T细胞、血管生长因子等与皮肤损害相关.感染、损伤、体力劳动等因素与关节病性银屑病患者发病相关性较高;吸烟、饮酒与关节病性银屑病的发病似乎呈负相关.     

Psoriasis arthropathy and HLA-B51: report of 5 cases

Psoriasis arthropathy (PsA) is a chronic inflammatory arthropathy characterized by the association of arthritis with psoriasis. Although the precise mechanisms of PsA still remain obscure, several genetic and environmental factors have been suggested to play important roles. HLA‐B51 has been strongly associated with Behçet's disease; however, its association with PsA has not been documented. We describe herein five Japanese patients (4 males and 1 female) with PsA and positive for HLA‐B51. The clinical forms defined by Moll and Wright revealed that the polyarticular pattern was noted in two cases, and oligoarticular, distal, and spondyloarthropathy patterns were noted in one case each. Positive rheumatoid factor was detected in one patient, and antinuclear antibody in two patients. The other HLA subclasses were A2 and A31 in 3 cases, respectively. HLA‐B51 was detected in 5 out of 17 patients with PsA examined in our department; in contrast, HLA‐B51 was not detected in 17 patients with psoriasis vulgaris. Our observations suggest that HLA‐B51 may play a role in the pathogenesis of PsA in the Japanese population.     

70例关节病性银屑病患者临床特征研究

目的 探讨关节病性银屑病（PsA）在银屑病中的比例及其临床特征。方法 对2014年1月至2015年1月诊断为银屑病的患者进行横断面研究,通过问卷调查,对疑为PsA患者用PsA分类标准（CASPAR标准）进行确诊,并对确诊为PsA及既往诊断过PsA的患者情况进行登记。两组间统计学分析用t检验,多组间用one?way ANOVA检验,率的比较采用χ2检验,检验均为双侧检验。结果 1 062例银屑病患者中,疑为PsA 125例,确诊PsA 70例（6.59%）,其中45例（64.29%）首次确诊,男∶女为2.1∶1。皮损类型以寻常性银屑病占多数,为50例（71.43%）。临床类型如下：非对称性少关节炎性23例,占32.86%、对称性多关节炎性19例,占27.14%、远端指间关节炎性10例,占14.29%、脊椎以及骶髂关节病性7例,占10.00%、残毁型关节炎性11例,占15.71%,各型间有重叠。PsA相对特征性的指趾炎及附着点,分别在14例（20.00%）和8例（11.43%）患者中出现。43例（61.43%）PsA患者出现了指（趾）甲改变。结论 掌握PsA的临床特征,早期诊断,对患者的长期预后具有重要意义。     

Therapeutic depletion of myeloid lineage leukocytes by adsorptive apheresis for psoriatic arthritis: Efficacy of a non‐drug intervention for patients refractory to pharmacologics

Psoriatic arthritis (PsA), a chronic inflammatory arthropathy associated with psoriasis, is an intractable immune disorder and refractory to pharmacological intervention. We assessed efficacy of selective depletion of myeloid lineage leukocytes in patients with PsA in a multicenter setting. A total of 20 patients with moderate to severe PsA refractory to conventional and biological disease‐modifying antirheumatic drugs were included. Eligible patients had 3 points or more in the classification criteria for PsA. Each patient received five sessions, once a week, of adsorptive granulocyte and monocyte apheresis (GMA) with the Adacolumn^®. The primary efficacy outcome was 20% or more decrease in the American College of Rheumatology score 20 (ACR20). Partial responders could receive an additional five GMA sessions. Of 20 patients, two did not complete the study, nine responded to five GMA sessions and nine received 10 sessions. At the first evaluation 2 weeks after the last GMA session, 13 of the 20 (65.0%) patients achieved ACR20. ACR20 was maintained in seven of 10 (70%) and five of 10 (50%) patients at the follow‐up evaluation points 8 and 20 weeks after the last GMA session, respectively. GMA was well tolerated without any safety concern. This study demonstrates that GMA with the Adacolumn was effective with good safety profile in patients with PsA refractory to pharmacologicals. The results indicate a major role for myeloid leukocytes in the immunopathogenesis of PsA. A large controlled study is warranted to fully evaluate the efficacy of Adacolumn GMA in patients with PsA.     

Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study)

Background Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown. Objectives To compare three PsA screening questionnaires in a head‐to‐head study using CASPAR (the Classification Criteria for Psoriatic Arthritis) as the gold standard. Methods This study recruited from 10 U.K. secondary care dermatology clinics. Patients with a diagnosis of psoriasis, not previously diagnosed with PsA, were given all three questionnaires. All patients who were positive on any questionnaire were invited for a rheumatological assessment. Receiver operating characteristic (ROC) curves were used to compare the sensitivity, specificity and area under the curve of the three questionnaires according to CASPAR criteria. Results In total, 938 patients with psoriasis were invited to participate and 657 (70%) patients returned the questionnaires. One or more questionnaires were positive in 314 patients (48%) and 195 (62%) of these patients attended for assessment. Of these, 47 patients (24%) were diagnosed with PsA according to the CASPAR criteria. The proportion of patients with PsA increased with the number of positive questionnaires (one questionnaire, 19·1%; two, 34·0%; three, 46·8%). Sensitivities and specificities for the three questionnaires, and areas under the ROC curve were, respectively: Psoriatic Arthritis Screening Evaluation (PASE), 74·5%, 38·5%, 0·594; Psoriasis Epidemiology Screening Tool (PEST), 76·6%, 37·2%, 0·610; Toronto Psoriatic Arthritis Screen (ToPAS), 76·6%, 29·7%, 0·554. The majority of patients with a false positive response had degenerative or osteoarthritis. Conclusion Although the PEST and ToPAS questionnaires performed slightly better than the PASE questionnaire at identifying PsA, there is little difference between these instruments. These screening tools identify many cases of musculoskeletal disease other than PsA.     

Prospective assessment of body weight and body composition changes in patients with psoriasis receiving anti-TNF-α treatment

Tumor necrosis factor (TNF)-α is a pro-inflammatory cytokine associated with psoriasis pathogenesis. Anti-TNF-α therapies are effective in psoriasis. A significant weight gain has been reported in patients treated with anti-TNF-α agents. The aim of the present study was to evaluate the body composition changes in psoriatic patients receiving anti-TNF-α therapies according with disease phenotype. Forty patients affected with psoriasis were followed up for 24 weeks and divided into two groups: psoriasis vulgaris (PsO) and psoriatic arthritis (PsA). Anthropometric, blood biochemical, body composition parameters, resting metabolic rate, and disease activity indexes were measured at baseline and at week 24. After 24 weeks of anti-TNF-α administration, the disease activity indexes and concentration of inflammatory markers were significantly decreased. Seventy-five percent of PsO and 60% of PsA patients had an increase in body weight. Weight changes correlated with fat mass gain in the PsO group, and with fat and lean mass gain in the PsA group. In the present study, we demonstrated that a blockage of TNF-α bioactivity is related with fat and lean mass gain in both PsO and PsA subjects. The anti-TNF-α therapies could play a key role in the cross talk between adipose tissue and skeletal muscle, mediated by the reduction of TNF-α and interleukin-6 production.     

New developments in our understanding of psoriatic arthritis and their impact on the diagnosis and clinical management of the disease

Psoriatic arthritis (PsA) is a spondyloarthritis with a comorbid association with psoriasis. Without appropriate treatment it can be progressive, severe, deforming and destructive. It has long been recognized that subsets of PsA patients exist, characterized by different patterns of joint involvement. Associations between development of PsA and certain human leukocyte antigens (HLA) have been established. Evidence now suggests that progression of PsA is also genetically determined. The presence of one allele (HLA‐B*27) has been associated with a distinct phenotype characterized by early joint involvement, whereas development of musculoskeletal symptoms is much slower in patients with another allele, C*06. Dermatologists need to consider what these differences in genotypes and phenotypes mean for clinical practice. Delay in the diagnosis of PsA is a significant contributor to poor patient outcomes, but there is evidence that PsA is underdiagnosed among psoriasis patients attending dermatology clinics. Dermatologists need to identify PsA symptoms among their psoriasis patients and refer for rheumatological assessment where appropriate. Treatment should address all aspects of the disease, including skin, nail and joint symptoms as well as physical functioning and quality of life. The existence of distinct phenotypic and genetic PsA subsets means dermatologists need to consider which drugs are likely to be most efficacious in which patient populations. Stratification of PsA according to susceptibility genes may in future help identify patients requiring more aggressive treatment to prevent progression. Biologic therapies show efficacy in PsA, but the patient populations of clinical trials are not always representative of patients treated with biologics in clinical practice.     

银屑病性关节炎累及颞颌关节2例国内首报

目的:探讨银屑病性关节炎颞颌关节受累的临床及影像学特点。方法:分析我院2例银屑病性关节炎患者颞颌关节受累的临床、影像、实验室检查特点,并对文献进行复习。结果:2例银屑病性关节炎患者,颞颌关节疼痛、晨僵、周围肌肉酸痛及压痛,CT检查见下颌骨髁状突骨皮质侵蚀,骨皮质下囊肿,关节面骨质硬化,关节窝扩大。结论:银屑病性关节炎可累及颞颌关节,但易被忽略。     

Psoriasis,psoriatic arthritis and type 2 diabetes mellitus: a systematic review and meta‐analysis

Several observational studies have assessed the association between psoriasis, psoriatic arthritis (PsA) and type 2 diabetes mellitus, with inconclusive results. We set out to investigate the association between psoriasis, PsA and type 2 diabetes mellitus. Observational studies assessing the relationship between psoriasis or PsA and type 2 diabetes mellitus up to December 2012 were identified by electronic and hand searches in Medline, Embase, PubMed, the Cochrane Database of Systematic Reviews and Google Scholar. For each study we collected the first author's last name, publication year, country of origin, study design, characteristics of participants (sample size, age and sex), the variables incorporated into the multivariable analyses, and the odds ratios (ORs) of psoriasis associated with diabetes along with the corresponding 95% confidence intervals (CIs). From the data provided in each article, the crude OR was also calculated. Forty‐four observational studies (in 37 articles) were identified for the final analysis. The pooled OR from random‐effects analysis was determined to be 1·76 (95% CI 1·59–1·96). The highest risk was for patients suffering from PsA (OR 2·18, 95% CI 1·36–3·50). We also observed a dose effect in the risk of suffering from type 2 diabetes mellitus, as patients considered as having severe psoriasis had higher risk (OR 2·10, 95% CI 1·73–2·55) than the pooled OR. We perform meta‐regression and sensitivity analyses to explore sources of heterogeneity among the studies and to determine how they would influence the estimates, and found no significant influence in the results of the meta‐analyses. The findings support the association between psoriasis, PsA and type 2 diabetes mellitus. Some caution must be taken in the interpretation of these results because there may be heterogeneity between studies.     

The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics

Background Estimates of psoriatic arthritis (PsA) prevalence among psoriasis patients vary widely (5–40%). The time to development of PsA in patients with plaque psoriasis also remains unclear. Objectives To examine whether length of time since diagnosis of psoriasis affects risk of developing PsA, and to assess differences in quality of life (QoL), work‐related issues, comorbidities and healthcare resource utilization (HCRU) for patients with PsA vs. psoriasis. Methods This large cross‐sectional observational study was conducted in the UK, Italy, France, Spain and Germany in 2006. Dermatologists who actively treated patients with psoriasis recruited 10 consecutive patients with psoriasis. Presence of PsA, body surface area (BSA) affected with psoriasis and HCRU were recorded; patients completed EUROQoL (EQ5D) and employment disadvantages questionnaires. Results Patients with psoriasis (n = 1560) included 126 with PsA. Ninety per cent of these patients with PsA were seen by dermatologists who involved a rheumatologist in the care of their patients with PsA. Survival analysis indicated that the incidence of PsA among psoriasis patients remained constant (74 per 1000 person‐years), while the prevalence increased with time since diagnosis of psoriasis, reaching 20.5% after 30 years. In addition, those with high BSA currently affected by psoriasis were more likely to have developed PsA (P < 0.028). PsA patients reported reduced QoL compared with psoriasis patients (EQ5D score: 0.56 vs. 0.82: P < 0.0005), as well as more work problems. PsA patients were more likely to be hospitalized (0.27 ± 0.84 vs. 0.14 ± 0.71 per year; P < 0.0005) and have additional comorbidities than those without PsA. Conclusions The incidence of PsA was constant after initial diagnosis of psoriasis, leading to a higher prevalence of concomitant PsA over time. PsA is associated with decreased QoL and increased work‐related problems, HCRU and comorbidities. Dermatologists should screen for PsA in their patients, especially long‐standing patients who did not initially present with PsA.