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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 200-203

Clinical profile of psoriatic arthropathy




Correspondence Address:
SP Chaudhary Ray


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  Abstract 

Thirty patients of psoriatic arthritis were examined for, elucidation of Epidemiological aspects and clinical variation of this disease. Mill's and Wright criteria for the diagnosis of was applied. Arthritis antedated psoriasis of skin in 13.3% and the onset was acute in .36.7%. The types of arthritis observed were polyarticular in 33.3% mixed in 2D%, oligoarthritis in 16.7%, DIP in 13.3%, sacroilitis 'in 10% and arthritis mutilans in 6.7%. The joints found to be most frequently involved were proximal 'interphalangeal (66.6%) and distal interphalangeal joints (65%) of I the hands. No distinct pattern of dermal psoriasis in psoriatic arthritis was observed., Nail changes were observed in 76.60/c of patients. No other eye changes except blepharitis was seen in two (7%) patients.HLA-A and HLA-B phenotyping was done in 16 patients, among them 12 patients had peripheral type of psoriatic arthritis HIA-A 1 B 17 and B 27 were present in 6 (20%),9 (30%) and 2 (7%) patients respectively.


Keywords: Psoriatic arthropathv, Psoriasis and HLA phenotyping.


How to cite this article:
Ray SC, Singh T, Kaur I, Suri S, Sehgal S, Kaur S. Clinical profile of psoriatic arthropathy. Indian J Dermatol Venereol Leprol 1990;56:200-3

How to cite this URL:
Ray SC, Singh T, Kaur I, Suri S, Sehgal S, Kaur S. Clinical profile of psoriatic arthropathy. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Oct 28];56:200-3. Available from: https://www.ijdvl.com/text.asp?1990/56/3/200/3524


For a long time, the joint abnormalities associated with psoriasis were considered part of the spectrum of rheumatoid arthritis. Only recently psoriatic arthritis has been recognized as a distinct entity included in the seronegative spondyloarthropathies.[1],[2] The clinical and laboratory criteria for the classification of this disease have been detailed by Mill and Wright[3] only a decade back.

Because of scarcity of data in India[4],[5],[6] about the nature of psoriatic arthropathy, present study was undertaken for elucidation of epxJemiological aspects and clinical variation of this disease.


  Materials and Methods Top


Thirty patients of psoriatic arthropathy were taken up from psoriasis clinic of the department of Dermatology at the Nehru Hospital attached to Postgraduate Institute of Medical Education and Research. After proper clinical evaluation, all the patients were classified according to the criteria of Moll and Wright.[3] A joint was considered involved if there was history of swelling or on examination swelling/tenderness could be elicited. Eye check up was done in all cases. X-rays of the involved joints and the contralateral joints were taken. Both anteroposterior and oblique views of pelvis were taken for radiological assessment of sacroiliac joints. The latex test and haemagglutination test were used for the detection of rheumatoid factor. Blood was examined for ANF, LE cell and C­reactive protein. HLA phenotyping for HLA-A and HLA-B was done in 16 cases.


  Results Top


Out of 30 patients 22 were males and 8 females. The mean age of onset of psoriasis was 36 years and that of psoriatic arthritis 41 years. Nature of onset of psoriatic arthritis was insidious in 63.3% and acute in 36.7%. Arthritis preceded the skin lesions in 13.3%, where as skin lesions preceded arthritis in 73.3% and in the rest (10%) both appeared simultaneously. One patient did not have any skin lesion but characteristic nail changes were present. In majority of the patients (63%) skin involvement was less than 20% of the total surface areas only in seven (23.3%) out of 30 cases skin involvement was more than 50% of the total surface area. The pattern of disease in 83.3% was psoriasis vulgaris plaque type. Other types were localized involvement of scalp, palmoplantar, generalized pustular type and erythrodermia. Each of these types were present in 3.3% of cases. Nail changes were present in 76.6%. The changes observed were pitting in 66.6%, discolouration in 63.3%, ridging and thickening in 53.4%, subungual hyperkeratosis and distal onycholysis in 50%, salmon patch in 20% and oil drop lesion in 3.3%.

The clinical types of joints involved is shown in [Table - 1]. The frequency of involved joints observed in the present study is shown in [Table - 2]. Other than blepharitis due to psoriasis in two patients and senile cataract probably unrelated to psoriasis in three patients, no other eye changes were observed. Radiological evidence of sacrolitis was observed in 43.3% of cases. HLA-A and HLA-B phenotyping was done in 16' patients of which 12 patients had peripheral arthritis, 2 patients had sacroilitis and the other 2 patients had involvement of both peripheral and axial skeleton. Although results are not strictly comparable due to small number of cases, a positive association of HLA-A1 and - B17 with the peripheral psoriatic arthritis was found to be of statistical significance. Two patients with sacroilitis had positive HLA B27. Only one patient had positive sheep red blood cell agglutination with a titre of 1:16. One patient (3.3%) revealed ANF in the serum.


  Comments Top


Psoriatic arthritis is believed to have a slight female preponderance[1],[7],[8],[9] Present study however revealed a male preponderance (2.7:1). Another study by Barraclough et al[10] also reported male dominance (1.7:1). Like earlier studies[7],[10],[11]. our study revealed that arthritis antedates psoriatic skin lesions (13.3%), and the nature of arthritis may be acute (36.7%). Although Lecizinsky[12] and Scarpa[8] found arthritis to be severe in patients with extensive skin lesions, our observations shared the findings of Moll and Wright[3] that there is no distinctive pattern of dermal psoriasis in psoriatic arthritis. Similar to the findings of Roberts et al[7] and Scarpa et al[8] we have found that a large number of patients (76.6%) do have nail changes suggestive of psoriasis. One patient presented only with nail changes and joint pain. Nail changes were in the form of pitting, discolouration, thickening and subungual hyperkeratosis. X-ray of the hands showed proliferation of the bone at the base of the distal phalanges and rheumatoid factor was negative. This suggests that dermatological examination of seronegative arthritis is always mandatory for early diagnosis of the nature of arthropathy.

All forms of psoriatic arthropathy as mentioned by Moll and Wright[3] were found in the present study. Polyarticular type (rheumatoid arthritis like) was the commonest form of presentation (33.3%). This differs from the observations of Moll and Wright[3], who found 70% patients having asymmetric oligoarthritis. Malaviya[6] and Scarpa et al[8] also found rheumatoid arthritis like psoriatic arthropathy as the commonest presentation. The findings of the present study are consistent with the established observations that psoriatic arthropathy affects both large and small joints but the small joints of hands and feet are predominently involved[7],[11] In this study the joints found to be most frequently involved were proximal interphalangeal (PIP) joints in 66.6%, next in frequency was distal interphalangeal (DIP) joint involvement in 65% of cases.These findings differ from the earlier studies of Roberts et al[7] and Leonard et al[13], where metacarpophalangeal joints (MCP) were found to be most frequently involved. Roberts et a1[7] observed involvement of PIP in 49%. DIP in 36% and MCP in 51%. In the study of Leonard et al[13] frequency of involvement was PIP in 63%, DIP in 60% and MCP in 70%.

HLA-A1 and B-17 was found to have positive association with peripheral type of psoriatic arthritis. Woodrow et al[14] also found positive association of HLA-B17 with peripheral type of psoriatic arthritis. Association of HLA-A1 with psoriasis of skin is known[15] Though this present study with the local population indicates a positive association of HLA-B17 and -Al with the peripheral type of psoriatic arthritis but a larger population of patients is needed to be studied for further confirmation.

 
  References Top

1.Moll JMH and Wright V Psoriatic arthritis. Semin Arthritis Rheum, 1973; 3 : 55-78.  Back to cited text no. 1    
2.Wright V and Moll JMH Seronegative Polyarthritis, Amsterdam, North-Holland, 1976; 169-236.  Back to cited text no. 2    
3.Moll JMH and Wright V : Familiar occurrence of Psoriatic Arthritis, Ann Rheum Dis, 1973, 22 : 181­-201.  Back to cited text no. 3    
4.Malaviya AN, Mehra NK, Adhar GC et al : The clinical spectrum of HLA B27 related rheumatic diseases in India, J Assoc Phy Ind, 1979; 27 : 487-492.  Back to cited text no. 4    
5.Malaviya AN, Dasgupta B, Tiwari SC et al : Psoriatic arthritis; a clinical and immunological study in 15 cases from India, J Assoc Phy Ind, 1984; 32 : 403­405.  Back to cited text no. 5    
6.Malaviya AN : Psoriatic arthropathy (CME). Ind J Dermatol Venereol Leprol, 1984; 50 : 127-130.  Back to cited text no. 6    
7.Roberts MET, Wright V, Hill AGS et al : Psoriatic arthritis, Ann Rheum Dis, 1976; 35 : 206-219.  Back to cited text no. 7    
8.Scarpa R, Orient P, Pucino A et al : Psoriatic arthritis in psoriatic patients. Brit J Rheumatol, 1984; 23 246-249.  Back to cited text no. 8    
9.Kononen M, Torppa J and Lassus A : An epidemiological survey of psoriasis in the Greater Helsinikiarea, Acta Dermato Venereol, 1986; 124 (Suppl.)  Back to cited text no. 9    
10.Barraclough D, Russel AS and Percy JS : Psoriatic spondylitis, A clinical, radiological and scientiscan survey, J Rheumatol, 1977; 4 : 282-287.  Back to cited text no. 10    
11.Baker H, Golding DN and Thompson M : Psoriasis and arthritis, Ann Int Med, 1963; 58 : 909-925.  Back to cited text no. 11    
12.Lecinzinsky CG : The incidence of arthropathy in a ten year series of psoriasis cases, Acta Dermato­ Venereol, 1948; 28 : 482-487,  Back to cited text no. 12    
13.Leonard DG, O'Duffy and Rogers RS : Prospective analysis of psoriatic arthritis in patients hospitalized for psoriasis, Mayo Clin Proc, 1978; 53 : 511-518.  Back to cited text no. 13    
14.Woodrow JC and II chysyn A : HLA antigen in psoriasis and psoriatic arthritis, J Med Gen, 1985; 22 : 492-495.  Back to cited text no. 14    
15.Sarajuki, Matsushita S and Matsumato H : Joint report of the Asian Histocompatibility Workshop, Japan, 1986.  Back to cited text no. 15    


    Tables

[Table - 1], [Table - 2]



 

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