ARD：合并银屑病的脊柱关节病患者疾病活动度更高

银屑病是脊柱关节病常见的临床表现。然而，银屑病对有炎性下腰背痛（IBP）患者的临床、功能和影像特征的影响与脊柱关节病的相关性尚不明确。为进一步确定脊柱关节病的患病率及其对近期发病的可能诊断为脊柱关节病的IBP患者的影响。

在DESIR队列的692例患者（平均年龄33.3±8.5岁，女性占53.8%，58.3%的患者人白细胞抗原B27阳性）中，确定银屑病的患病率。比较有无银屑病的患者的人口学资料、影像学特征和血液检验指标。

银屑病的患病率为16.6%。相较无银屑病的患者，有银屑病的患者存在更多的起止点炎（59.1% vs 47.5%; p=0.02）、疾病活动度更高（BASDAI 4.8±1.8 vs 4.4±2.0; p=0.05），功能状态更差（BASFI 3.6±2.2 vs 3.0±2.3; p=0.006; SF-36 (physical function) 61.9±24.4 vs 66.9±24.9; p=0.04）。合并银屑病的患者C反应蛋白（p=0.02）、总胆固醇（p=0.01）和甘油三酯（p=0.02）的水平更高。两组患者在X线摄像或者MRI检查的脊柱结构改变和骶髂关节病变分级方面无显著差异。然而，跟腱超声检查提示，银屑病与骨侵蚀（p=0.0003）和异常的血管生成（p=0.04）相关。多元回归分析提示，BASFI评分（p=0.03）、胆固醇水平（p=0.02）、指趾炎（p=0.0006）及银屑病家族史（p<0.0001）是发生银屑病的独立预测因素。

近期发病的可能诊断为脊柱关节病的IBP患者中，银屑病的发生与活动性中轴疾病和频繁发作的起止点炎及指趾炎相关。

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Psoriasis and phenotype of patients with early inflammatory back pain.
BACKGROUND
Psoriasis is an important clinical feature in spondyloarthritis. However, the influence of psoriasis on the clinical, functional and imaging features of patients with inflammatory back pain (IBP) related to spondyloarthritis is not known.
OBJECTIVES
To determine the prevalence of psoriasis and its impact in patients with recent IBP suggestive of spondyloarthritis.
METHODS
The prevalence of psoriasis was determined in 692 patients (mean age 33.3±8.5 years, 53.8% female, 58.3% human leucocyte antigen B27 positive) included in the DESIR cohort. Demographic characteristics, imaging features and blood tests of patients with and without psoriasis were compared.
RESULTS
The prevalence of psoriasis was 16.6%. Patients with rather than without psoriasis more often presented with enthesitis (59.1% vs 47.5%; p=0.02) and had more active disease (BASDAI 4.8±1.8 vs 4.4±2.0; p=0.05) and poorer functional status (BASFI 3.6±2.2 vs 3.0±2.3; p=0.006; SF-36 (physical function) 61.9±24.4 vs 66.9±24.9; p=0.04). Patients with psoriasis showed higher levels of C-reactive protein (p=0.02), total cholesterol (p=0.01) and triglycerides (p=0.02). The two groups did not differ in structural changes as assessed by standard x-rays or MRI at the spinal and sacroiliac levels. However, ultrasonography of the Achilles tendon revealed psoriasis associated with bone erosions (p=0.0003) and abnormal vascularisation (p=0.04). Multivariate regression analysis revealed BASFI score (p=0.03), cholesterol level (p=0.02), dactylitis (p=0.0006) and family history of psoriasis (p<0.0001) as independent predictors of psoriasis.
CONCLUSIONS
In patients with recent IBP suggestive of spondyloarthritis, psoriasis is associated with active axial disease and frequent concomitant enthesopathy and dactylitis.