Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study
Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study
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DOI：
10.1093/rheumatology/keac664
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发表时间：
2022-11-28
期刊：
影响因子：
5.5
通讯作者：
Yoshizaki, Ayumi
中科院分区：
文献类型：
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作者：
Fukasawa, Takemichi;Toyama, Satoshi;Yoshizaki, Ayumi
目的银屑病样关节炎（PsA）是银屑病最严重的合并症之一。虽然需要对PsA进行早期干预，但PsA发展的危险因素尚不清楚。这是第一项前瞻性研究，以评估银屑病患者甲襞毛细血管（NFC）变化的临床意义。方法我们对449例未经全身治疗或局部手指治疗的银屑病患者进行了前瞻性队列研究。通过皮肤镜和毛细血管镜观察NFC，分析NFC异常（包括甲襞出血（NFB）和毛细血管扩张）与PsA患病率、新发PsA发生率以及血清TNF-α、IL-17 A和IL-23水平的相关性。结果449例患者中，寻常型银屑病236例，寻常型银屑病213例。PsA患者的NFB和毛细血管扩张均显著高于对照组（34.7% vs 84.5%，P < 0.0001; 25.4% vs 100%，P < 0.0001）。此外，PsV患者在发生PsA之前进行前瞻性观察（平均21个月，95% CI 2.77个月）。多变量分析表明，NFB和毛细血管扩张的出现是PsA发展的预测因子（HR 2.75，95% CI 1.38，5.47和HR 4.49，95% CI 2.25，8.96）。NFC异常的程度也与PsA的严重程度和血清细胞因子水平相关。结论NFC异常可作为银屑病患者PsA的预测指标，其程度可作为银屑病严重程度的指标。
Objectives PsA is one of the most serious comorbidities associated with psoriasis. While the early intervention in PsA is demanded, risk factors of PsA development are not well-known. This is the first prospective study to evaluate the clinical significance of nailfold capillary (NFC) changes in patients with psoriasis. Methods We conducted a prospective cohort study in a population of 449 psoriasis patients who had not been treated with systemic therapy or topical finger therapy. NFCs were observed by dermoscopy and capillaroscopy, and the correlation of NFC abnormalities, including nailfold bleeding (NFB) and enlarged capillaries, with the prevalence of PsA, incidence of new PsA, and serum levels of TNF-a, IL-17A and IL-23 were analysed. Results Detailed examination at the time of inclusion revealed that of 449 patients, 236 had Psoriasis vulgaris (PsV) and 213 had PsA. Both NFB and enlarged capillaries were significantly more frequent in patients with PsA (34.7% vs 84.5%, P < 0.0001; 25.4% vs 100%, P < 0.0001). In addition, PsV patients were prospectively observed before they developed PsA (mean 21 months, 95% CI 2, 77 months). Multivariate analysis suggested that the appearance of NFB and enlarged capillaries was a predictor of PsA development (HR 2.75, 95% CI 1.38, 5.47 and HR 4.49, 95% CI 2.25, 8.96, respectively). The degree of NFC abnormalities also correlated with the severity of PsA and serum cytokine levels. Conclusions NFC abnormalities were suggested to be a predictor of PsA in psoriasis patients, and at the same time, its degree could be an indicator of disease severity.