Session Type: Abstract Submissions (ACR)
a) To determine differences in the prevalence of inflammatory articular disease (IAD) in patients with cutaneous psoriasis when applying clinical, ultrasound (PDUS) or radiological diagnostic criteria.
b) To determine the prevalence of PsA in these patients, applying different definitions for the initial stem of the CASPAR criteria, and to compare this prevalence with that based on clinical judgment.
Descriptive, observational, cross-sectional study of 122 patients referred from the primary care with a confirmed diagnosis of cutaneous psoriasis, without arthritis.
For the diagnosis of IAD, the following criteria were used:
Peripheral arthritis: a) Clinical (TJC>0 or SJC>0 (78/76)), b) PDUS (carpal, MCP, PIP, MTsP, carpal tendons, hands, feet tendons), c) Radiological (hands and/or feet erosions).
Spine: a) Clinical (inflammatory back pain (IBP) (4/5) and/or nocturnal and VAS overall spinal pain past week >5, b) Radiological (sacroiliitis grade II unilateral or higher).
Entheseal: a) Clinical (MASES plus lateral and medial epycondile, quadriceps tendon, proximal and distal patella, plantar aponeuroses). b) PDUS (lateral and medial epycondile, quadriceps tendon, proximal and distal patella, aquilles tendon plantar aponeuroses)
Prevalence of IAD was obtained, according to different definitions. PsA prevalence was also determined according to CASPAR criteria and clinical judgement. Agreement was evaluated by the Kappa’s index.
Criteria for peripheral arthritis: clinical criteria 12 (9.8%), PDUS 16 (15%) and erosions 20 (19%). Of 122 patients, 41 (41.4%) met at least one of the criteria for peripheral arthritis. None of them met all three criteria.
Criteria for spinal disease: IBP 8 (12.3%), VAS overall spinal pain in the past week>5 22 (18%), unilateral sacroiliitis grade II or higher 17 (15.5%). Of the patients studied, 5 (4.4%) met the radiological criteria plus one of the clinical criteria. None of them met the 3 criteria altogether.
Criteria for entheseal disease: clinical 13 (10.7%), PDUS 40 (32.8%). Of the 122 patients, 45 (36.9%) met one of this two criteria, 8 patients met both of them.
Prevalence of inflammatory articular disease, based on clinical criteria, was 44.2% (95% CI: 33.1%-52.3%). By combining clinical, ultrasound and radiological results, the prevalence was 61.8% (95% CI: 51.8%-71.7%).
Using only clinical criteria for the diagnosis of inflammatory articular disease, PsA prevalence according to CASPAR criteria was 27.2% (95% CI: 16.9%-37.5%). Combining clinical, ultrasound and radiological criteria, the prevalence was 34.7% (95% CI: 24.6%-44.8%). Only 12 (9.8%) of the patients had PsA according to clinical judgment. Agreement between clinical judgment and CASPAR criteria was low, both when clinical criteria (Kappa=0.247) or clinical+ultrasound+radiologic criteria (Kappa=0.140) were used to define IAD.
The prevalence of PsA in patients with psoriasis varies from 27.2% to 34.7%, according to the definition of the initial stem in CASPAR criteria. On the other hand, only 9.8% were diagnosed of PsA based on clinical judgment. These data suggest the need for clarifying the stem definition of CASPAR criteria.
*Grant from the Ministery of Health PI080789
J. L. Fernandez-Sueiro,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/differences-in-the-prevalence-of-inflammatory-articular-disease-in-psoriatic-patients-applying-clinical-ultrasound-andor-radiological-data-implications-in-the-classification-of-psoriatic-arth/