The burden of progression of psoriatic arthritis. All-Russian register data

Background. Psoriatic arthritis (PsA) is a complex immune-mediated disease in which a third of patients with psoriasis (PsO) have a inflammatory lesion of both the musculoskeletal system (peripheral joints and axial structures) and extra-articular manifestations (dactylitis, enthesitis, nail PsO, uveitis and inflammatory bowel disease). Aim. To assess the burden of PsA progression in real practice according to the Russian register of PsA patients. Materials and methods. Seven hundred thirty seven - M/F=350 (47.5%)/387 (52.5%) - patients with PsA from the Russian register of PsA patients were included. Mean age 47.4 +/- 12.7 yrs., duration of PsO 200.6 +/- 158.9 mo., PsA - 79.6 +/- 81.9 mo. All patients were divided into 2 groups by PsA duration: 1st gr <= 36 mo - 288 (39.1%) and 2nd gr >36 mo - 449 (60.9%). All patients underwent standard clinical examination of PsA activity. Tender (68) and swelling (66) joint count (TJC, SJC), DAPSA, LEI, tenderness of the plantar fascia, PsO BSA (%), PASI, HAQ-DI, PsAID-12, BMI (kg/m(2)), ESR (mm/h), CRP (mg/l) and comorbidities by ICD-10 were evaluated. Parametric and non-parametric methods of statistical analysis were used. All p<0.05 were considered to indicate statistical significance. Results. In patients with PsA duration >36 mo we found significant prevalence of erosions by X-Ray, axial PsA, BMI>30 kg/m(2), HAQ-DI>1, PsAID-12>4, arterial hypertension, metabolic syndrome and overall comorbidity (p<0.05). There were no significant differences between groups in PsO severity by BSA>3%, PASI>1, LEI>1, TJC, SJC, dactylitis, ESR>30 mm/h, CRP>10 mg/l, DAPSA, diabetes mellitus, hyperlipidemia, coronary heart disease and liver damage (p>0.05). Conclusion. Long-standing stage PsA is associated with erosions, axial PsA, worst health related quality of life, functional disability and increased cardiometabolic disorders and overall comorbidity. Our results support the idea to start bDMARDs at early stage of PsA, it can improve better outcomes.