RESUMO
The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to Classification of Psoriatic Arthritis (CASPAR) criteria, Assessment of Spondyloarthritis International Society (ASAS) peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % had nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was of 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs 10 years, p = 0.02), and a higher frequency of nail involvement (88.2 vs 49.4 %, p = 0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs 1.2 %, p = 0.0006 and 80 vs 16.7 %, p = 0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding a proper classification.
Assuntos
Artrite Psoriásica/classificação , Artrite Psoriásica/epidemiologia , Classificação/métodos , Psoríase/epidemiologia , Adulto , Artrite Psoriásica/diagnóstico , Vértebra Cervical Áxis/diagnóstico por imagem , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Fator Reumatoide/sangue , Espondilartrite/diagnósticoRESUMO
The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to CASPAR criteria, ASAS peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs. 10 years, p = 0.02), and a higher frequency of nail involvement (88.2 vs. 49.4 %, p = 0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs. 1.2 %, p = 0.0006 and 80 vs. 16.7 %, p = 0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding a proper classification.
Assuntos
Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico , Psoríase/complicações , Psoríase/diagnóstico , Adulto , Artrite Psoriásica/classificação , Artrite Psoriásica/epidemiologia , Artrografia , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Feminino , Pé/diagnóstico por imagem , Mãos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Prevalência , Psoríase/epidemiologia , Fator Reumatoide/sangue , Reumatologia/normas , Articulação Sacroilíaca/diagnóstico por imagemRESUMO
La artritis psoriásica (APs) es una artropatía inflamatoria crónica de las entesis, articulaciones periféricas, y articulaciones sacroilíacas y espinales. Se caracteriza por tener un curso clínico variable y presentar varios subtipos clínicos. La artritis psoriásica posee características clínicas y de laboratorio que la distinguen de otras artritis, especialmente artritis reumatoidea (AR). En los últimos años, la presencia o ausencia de anticuerpos contra péptidos cíclicos citrulinados ha facilitado su distinción de la AR. La gran mayoría de pacientes afectados con APs responden al tratamiento tradicional con agentes antiinflamatorios no esteroideos y/o agentes antirreumáticos modificadores de enfermedad o de segunda línea, incluyendo metotrexato. Sin embargo, como también ocurre en la AR y otras espondiloartropatías, existe un subgrupo de pacientes con APs que exhiben una respuesta pobre al tratamiento tradicional yrequieren el uso de los nuevos agentes biológicos, los inhibidores del TNFa. Describiremos la evidencia que apoya el uso de estos agentes en la APs
Assuntos
Artrite Psoriásica , Artrite Psoriásica/classificação , Terapia Biológica , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
El uso de la ciclosporina en dermatología se ha difundido en la última década. Se han publicado muchos casos de psoriasis vulgar tratados con éxito. En relación al amnejo de las artritis psoriática con ciclosporina casi no se ha escrito nada. La remisión de la enfermedad se obtiene en pocas semanas, y la recaída es rápida al disminuir la dosis de ciclosporina o al suspender el tratamiento. Presentamos el caso de un paciente masculino, de 36 años de edad, con psoriasis vulgar y afectación de tipo eritrodérmico en un 80% de su seperficie corpérea. Su artritis psoriática era el tipo multilans en manos, ambas articulaciones tibiotásicas, codos, compromiso de las uñas de manos y pies. El paceinte evolucionó bien desde el punto de vista dermatológico. REcuperó el uso de sus manos. La fuinction de la pinza y el agarre le permitió su reintegración social. Además, el paciente tuvo grandes beneficios psicológicos al mejorar su relación familiar. Al bajar la dosis de la ciclosporina a 2 mg/kg/día el paciente nuevamente la remisión.
Assuntos
Artrite Psoriásica/classificação , Hanseníase , Psoríase/classificaçãoRESUMO
El diagnóstico de artritis psoriásica se hace cuandopsoriasis y artritis de presentan juntas, sin nódulos subcutáneos y usualmente seronegativa para factor reumatoideo (FR) (1). Wright en 1991 (2) simplificó la clasificación en tres grupos. Revisamos la literatura y no encontramos informes de neuropatía periférica ni osteólisi de la tibia, peroné y tarso en artritis psoriática. Informamos el caso de una paciente con las anteriores manifestaciones clínicas