Clinical Characteristics and Co-morbidities in Patients with Psoriatic Arthritis

Abstract

Introduction: Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis and occurs in association with psoriasis, a chronic recurring and disfiguring skin disease. There is increasing recognition that both conditions are associated with multitude of co-morbidities.

Objective: To delineate the clinical characteristics and co-morbidities in PsA patients attending a rheumatology clinic in Kathmandu valley.

Material and Methods: Patients with already developed psoriasis who were seeking medical attention for arthritis during the period between January 2013 to December 2015 were prospectively enrolled. Patients were evaluated both by a dermatologist and a rheumatologist. A structured format was used to record relevant clinical information on psoriasis, PsA, and co-morbidities.

Results: Among 55 patients with PsA, all were found to have plaque psoriasis mainly affecting extensor surfaces (64%), multiple areas (16%), and scalp (11%). Nail involvement was observed in 22% of patients. Symmetric polyarthritis was the most frequent (26%) form, followed by oligoarthrtis (18%), distal interphalangeal (DIP) joint arthritis (16%),
spondyloarthritis (13%), and enthesitis-dactylitis (7%). Two thirds of patients were either overweight or obese. Almost half (47%) were current or past smokers. Diabetes or pre-diabetes was observed in 7% of cases. Hypertension, hyperlipidemia and ischemic heart disease (IHD) were present in 20%, 16%, and 5% respectively. Fatty liver disease was observed in 13% of the tested patients and 15% of patients were on some psychotropic drugs.

Conclusion: Psoriasis with PsA was associated with both cardiovascular and non-cardiovascular co-morbidities. Doctors treating patients with these disorders should consider associated co-morbidities for better patient outcome.