Background/Purpose: There is a paucity of literature on the prevalence of psoriasis (Ps) and psoriatic arthritis (PsA) in patients with systemic lupus erythematosus (SLE). To determine whether there are overlaps among these autoimmune diseases, we investigated the prevalence of Ps and PsA in patients with SLE.

Methods: We examined the prevalence of Ps and PsA in 445 patients with SLE based on history, physical examination, laboratory and radiological studies performed between 01/01/1990 and 07/31/12. A diagnosis of psoriasis was made by a dermatologist or rheumatologist while the diagnosis of PsA was made on the basis of CASPER criteria (Arth Rheum 2006; 54: 2665). The diagnosis of SLE was based on ACR criteria (Arth Rheum. 1997; 40: 1725). Prevalence of SLE diagnostic criteria were compared between SLE patients with and without Ps (SLE/Ps+ and Ps-) and with and without PsA (SLE/PsA+ and PsA-). Statistical analyses were performed with chi-square test using Graphpad Prism software with p<0.05 considered significant.

Results: Among 445 patients with SLE, 23 (5.1%) had Ps, out of which 20, (4.5%) patients had PsA. In the general population, the prevalence of Ps and PsA are estimated to be 2% (Rev Bras Reumatol. 2012; 52: 630) and 0.25% (Rev Bras Reumatol. 2012;52:98), respectively. Therefore, the prevalence of PsA, but not Ps, was increased in SLE patients (p < 0.0001). The prevalence of malar rash, discoid rash, photosensitivity, and arthritis were increased while antiphospholipid antibodies were less common in SLE patient with concurrent Ps and PsA (Table 1). There was no significant association of Ps or PsA with seizures, psychosis, oral ulcers, serositis, proteinuria, anemia, leucopenia, thrombocytopenia, hemolytic anemia, anti-Sm, or anti-DNA.

Table 1. Prevalence of SLE diagnostic criteria in patients with (SLE/Ps+) and without psoriasis (SLE/Ps+) as well as in patients with (SLE/PsA+) and without psoriatic arthritis (SLE/PsA+) in a cohort of 445 SLE subjects. The data were analyzed with chi-square test.

		Malar Rash	Discoid Rash	Photosensitivity	Arthritis	APLA
SLE/Ps+	Present	11	4	13	21	1
	Absent	12	19	10	2	22
SLE/Ps-	Present	118	21	142	211	108
	Absent	304	401	280	211	314
p value		0.0409	0.0118	0.025	0.0001	0.021
SLE/PsA+	Present	10	4	12	20	1
	Absent	10	16	8	0	19
SLE/PsA-	Present	119	21	143	213	108
	Absent	306	404	282	212	317
p value		0.0341	0.0043	0.0156	<  0.0001	0.038

Conclusion: PsA has increased prevalence in patients with SLE. Subjects with overlapping Ps and PsA may represent a distinct clinical entity within SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-psoriasis-and-psoriatic-arthritis-with-systemic-lupus-erythematosus/