A Clinical Study Of Subclinical Enthesitis And Synovitis In Patients With Vulgaris Psoriasis

Background: Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis. Patients with PsA may experience progressive joint disease, impaired physical function, and decreased quality of life. Increasing evidence supports earlier diagnosis of PsA can lead to improved outcome. Studies have found that some patients with subclinical arthritis go on to develop symptomatic PsA, so screening for patients with subclinical arthritis is of great significance for the early diagnosis of PsA.Objective: To investigate the prevalence of subclinical enthesitis and synovitis in patients with vulgaris psoriasis, and to identify potential influencing factors of and soluble biomarkers for subclinical enthesitis and synovitis among patients with psoriasis.Methods: A total of 52 patients with vulgaris psoriasis and 52 healthy controls underwent power Doppler ultrasonography examination of peripheral joints and lower limb entheses. We used logistic regression to assess the association of various demographic and clinical characteristics with subclinical synovitis. Fourteen different serum biomarkers were measured using ELISA and Multiplex Immunoassay technique. We used logistic regression and ROC analyses to identify potential serum biomarkers for subclinical synovitis.Results: The prevalence of subclinical synovitis was significantly higher in patients with psoriasis than in healthy controls, P <0.05; lower limb entheseal abnormalities on PDUS were not found in both groups. The mean PASI, NAPSI, ESR and TG levels were significantly higher in patients with subclinical synovitis than in patients without subclinical synovitis (all P values <0.05); the propotion of patients with first-degree family history, abnormal ESR, TC, and UA, smoking, and drinking was significantly higher in patients with subclinical synovitis than in patients without subclinical synovitis (all P values <0.05). The characteristics associated with subclinical synovitis included first-degree family history of psoriasis, high levels of PASI, NAPSI, ESR, TC and UA,smoking and drinking. The mean IL-12/23p40, VEGF-A, MMP-3 and COMP levels were significantly higher in patients with subclinical synovitis than in patients without subclinical synovitis (all P values <0.05). Increased levels of VEGF-A, RANKL, MMP-3 and COMP were associated with subclinical synovitis; corresponding areas under curve were 0.74, 0.78, 0.72 and 0.86, respectively.Conclusion: The prevalence of subclinical synovitis was significantly higher in patients with psoriasis than in healthy controls. The potential risk factors of subclinical synovitis for patients with vulgaris psoriasis included first-degree family history of psoriasis, high levels of PASI, NAPSI, ESR, TC and UA, smoking and drinking. VEGF-A,RANKL, MMP-3 and COMP were the potential biomarkers for subclinical synovitis in patients with vulgaris psoriasis and COMP was likely to be the best predictor among the four biomarkers.