The Incidence and Risk Factors for Psoriatic Arthritis in Patients With Psoriasis A Prospective Cohort Study
The Incidence and Risk Factors for Psoriatic Arthritis in Patients With Psoriasis A Prospective Cohort Study
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DOI：
10.1002/art.39494
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发表时间：
2016-04-01
影响因子：
13.3
通讯作者：
Gladman, Dafna D.
中科院分区：
文献类型：
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作者：
Eder, Lihi;Haddad, Amir;Gladman, Dafna D.
目标。目的评估银屑病患者银屑病关节炎（PsA）的发病率，并探讨其发展的危险因素。该研究被设计为一项前瞻性队列研究，涉及在研究入组时未诊断为关节炎的牛皮癣患者。收集了有关生活习惯、合并症、牛皮癣活动和药物的信息。患有炎性关节炎或脊柱炎的患者如果符合银屑病关节炎分类研究组的标准，则被归类为PsA。PsA的年发病率采用人均年事件分析来估计。Cox比例风险模型，包括固定和时间相关的解释变量，拟合以获得PsA发病的相对风险（RR）的估计值，在按性别分层的多变量模型中确定，并控制牛皮癣发病年龄。对随访8年的464例患者的数据进行分析。自入组以来的8年中，共有51名患者发生PsA。PsA的年发病率为每100名银屑病患者2.7例（95%可信区间2.1-3.6）。在多变量分析中，以下基线变量与PsA的发展相关：严重牛皮癣（RR 5.4， P=0.006），低教育水平（大学/学院与高中未完成的RR 0.22， P=0.005；高中毕业与高中未完成的RR 0.30， P=0.049），以及类维生素a药物的使用（RR 3.4， P=0.02）。在具有时间变量的多变量模型中，银屑病指甲刺痛（RR = 2.5， P=0.002）和葡萄膜炎（RR = 31.5， P=0.0002）与psa的发生相关。银屑病患者PsA的发生率高于先前报道。严重的银屑病表型、指甲凹陷、低教育水平和葡萄膜炎是银屑病患者PsA发展的预测因素。
Objective. To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis, and to identify risk factors for its development.Methods. The study was designed as a prospective cohort study involving psoriasis patients who did not have a diagnosis of arthritis at the time of study enrollment. Information was collected about lifestyle habits, comorbidities, psoriasis activity, and medications. Patients who developed inflammatory arthritis or spondylitis were classified as having PsA if they fulfilled the criteria of the Classification of Psoriatic Arthritis Study group. The annual incidence of PsA was estimated using an event per person-years analysis. Cox proportional hazards models, involving fixed and time-dependent explanatory variables, were fitted to obtain estimates of the relative risk (RR) of the onset of PsA, determined in multivariate models stratified by sex and controlled for age at onset of psoriasis.Results. The data obtained from the 464 patients who were followed up for 8 years were analyzed. A total of 51 patients developed PsA during the 8 years since enrollment. The annual incidence rate of PsA was 2.7 cases (95% confidence interval 2.1-3.6) per 100 psoriasis patients. The following baseline variables were associated with the development of PsA in multivariate analysis: severe psoriasis (RR 5.4, P=0.006), low level of education (university/college versus high school incomplete RR 0.22, P=0.005; high school graduate versus high school incomplete RR 0.30, P=0.049), and use of retinoid medications (RR 3.4, P=0.02). In multivariate models with time-dependent variables, psoriatic nail pitting (RR 2.5, P=0.002) and uveitis (RR 31.5, P=0.0002) were associated with the development of PsA.Conclusion. The incidence of PsA in patients with psoriasis is higher than previously reported. A severe psoriasis phenotype, presence of nail pitting, low level of education, and uveitis are predictive of the development of PsA in patients with psoriasis.