| Objective:To explore the clinical characteristics,TCM syndrome differentiation and regularity of drug treatment of psoriatic arthritis by retrospective study and analysis of the clinical data of psoriatic arthritis.Methods:According to the inclusion criteria,100 patients with psoriatic arthritis(PsA)were selected from rheumatology department and dermatology department of Jiangsu Traditional Chinese Medicine Hospital from 2008 to 2018.The clinical data of 100 psoriatic arthritis patients were registered in hospital electronic medical record system and imaging system,including gender,age,disease inducement,sequence of skin and joint involvement,skin lesion,joint involvement,nail change,family history,laboratory examination,imaging examination,TCM syndromes,treatment methods and drugs.The clinical characteristics of psoriasis vulgaris were summarized.The laboratory examination was compared with 100 cases of psoriasis vulgaris hospitalized at the same time.Cluster analysis and factor analysis were used to explore the TCM syndromes of psoriatic arthritis.Result:(1)100 cases of psoriatic arthritis were enrolled.66 males(66.00%),34 females(34.00%)and 1.56:1 males and females;aged 24-85 years,with an average age of(52,38±13.26);hospitalization time of 3-49 days,with an average hospitalization time of(17.14±5.99)days;27 cases(27.00%)with initial onset and 73 cases(73.00%)with relapse;17 cases(17.00%)with"psoriasis" family history,of which 15 cases(88.24%)had a history of psoriasis among the first-degree relatives.(2)The main types of skin lesions were common type(94.00%),including drip type(18.09%),plaque type(48.94%),coin type(15.96%),map type(6.38%),annular type(2.13%)and mixed type(8.51%).The stage of skin lesion was mostly in the progressive stage(46.00%)and most of them were the first rash(72.00%).The first clinical manifestation was rash,the time from rash to arthritis was 0.42-30 years,the average time was(9.32±8.28)years;the first clinical manifestation was arthritis,the time from arthritis to rash was 0.16-27.0 years,the average time was(9.32+8.28)years.The average time was(7.73±7.77)years,and 68%of the patients had no obvious inducement of arthritis or aggravation.The lesions mainly involved lower limbs(59.00%)and scalp(54.00%).Thirty-five cases(35.00%)had nail damage,most of which were deck thickening,turbidity,needle-like depression,nail stripping and crista longitudinalis.(3)Of the 100 patients,51%had proximal interphalangeal joint involvement,while 48%had knee joint involvement.Peripheral type(76.00%)was the main type of affected joint.Among 32 patients examined by color Doppler ultrasound,53.13%were classified as attachment point inflammation combined with synovitis according to the nature of affected joint tissue.(4)Compared with 100 patients with psoriasis vulgaris,the increase rate of WBC,NEUT,PLT and the decrease rate of LYM in patients with psoriatic arthritis were significantly higher than those in patients with psoriasis vulgaris(P<0.05).Among the inflammatory indicators,the increase rates of ESR and CRP in patients with psoriatic arthritis were significantly higher than those in patients with psoriasis vulgaris(P<0.05).The positive rates of ANA and HLA-B27 in patients with psoriatic arthritis were significantly higher than those in patients with psoriasis vulgaris(P<0.05).The increase rate of IgG and IgA in patients with psoriatic arthritis was significantly higher than that in patients with psoriasis vulgaris,while the decrease rate of complement C3 and complement C4 was significantly lower than that in patients with psoriasis vulgaris(P<0.05).(5)Among 100 patients with psoriatic arthritis,72 patients received different imaging examinations according to their clinical manifestations.The X-ray examination rate was 23.00%(23 cases),the positive rate was 56.52%,the CT examination rate of sacroiliac joint was 37.00%(37 cases),the positive rate was 62.16%,the MRI examination rate was 22.00%(22 cases),and the positive rate was 56.52%.86.36%,32.00%(32 cases)and 90.63%(positive rate).X-ray photography mainly showed the decrease of bone density,joint space narrowing and soft tissue swelling;CT images mainly showed the rough and underpolished articular surface,insect-like erosion changes under the articular surface,bone hyperplasia,heterogeneous osteosclerosis,joint space narrowing and so on.The main manifestations of MRI images were joint space narrowness,unclear,joint cavity effusion,accompanied by surrounding soft tissue swelling,etc.The main manifestations of joint ultrasound were synovial hyperplasia,thickening,joint cavity effusion,peritendon effusion,rough bone cortex and local osteophyte formation.(6)Through the analysis of KMO test,Bartlett spherical test,extraction factor and factor rotation of each syndrome factor,10 common factors were obtained,combined with professional knowledge,and merged into five most clinical combination of factors and syndromes.The syndrome differentiation of psoriatic arthritis was based on the frequency from high to high.The low order was rheumatism-heat-arthralgia syndrome(33.00%),liver-kidney deficiency syndrome(22.00%),phlegm-blood stasis-obstruction syndrome(18.00%),blood-heat-wind excess syndrome(16.00%)and yin-deficiency-internal heat syndrome(11.00%).(7)81 of 100 patients with PsA were treated with NSAIDs,89 with slow-acting antirheumatic drugs,25 with biological agents and 11 with glucocorticoids.Common treatment options are A:methotrexate+NSAIDs(+leflunomide);B:methotrexate+thalidomide+NSAIDs(mainly celecoxib,futalin,meloxicam);C:methotrexate+Tripterygium glycoside;D:hormone+NSAIDs+methotrexate;E:biological agents(Isepril,Infliximab,AdamAb)+methotrexate.Most patients were treated with combination of NSAIDs and two slow-acting antirheumatic drugs.According to whether or not to use biological agents,100 patients with PsA were divided into biological agents group and routine treatment group.The hospitalization days of patients treated with biological agents were significantly less than those of routine treatment group(P<0.05).86 patients were treated with Decoction of traditional Chinese medicine,including rheumatism-heat-arthralgia syndrome,clearing away heat and dampness,dispelling wind and removing arthralgia;deficiency of liver and kidney,nourishing liver and kidney,dispelling wind and dredging collaterals;phlegm-stasis-obstruction syndrome,removing phlegm and removing blood stasis and dredging collaterals;hyperactivity of blood-heat syndrome,clearing heat and detoxification,cooling blood and removing wind;yin-deficiency-internal heat syndrome,nourishing yin and invigorating body fluid,clearing waste heat.The main components of traditional Chinese medicine are clearing away heat and dampness,cooling blood and dispelling wind,tonifying liver and kidney,promoting blood circulation and dredging collaterals,which are basically consistent with the distribution of syndromes.(8)During hospitalization,there were 3 patients with leukopenia,2 patients with gastrointestinal reactions and 2 patients with liver injury.They were all improved by discontinuing suspicious drugs and actively treating with leukopenia,gastric mucosa protection and liver protection.Nine patients refused to use biological agents,and one patient was discharged automatically because of poor self-efficacy.Conclusion:(1)Psoriatic arthritis is more common in males than in females.Some patients have a family history of psoriasis.Patchy lesions are common,often involving the lower limbs and scalp.(2)Psoriatic arthritis can involve all joints of the whole body,and the proximal interphalangeal joints and knee joints are frequently involved.(3)PsA patients mostly suffer from psoriasis skin rash first,then arthritis symptoms.But there are also some patients with arthritis as the first clinical manifestation,which brings some difficulties to clinical diagnosis and treatment.(4)HLA-B27 positive is associated with the involvement of medial axis joint in patients with psoriatic arthritis.(5)The increase rate of ESR and CRP in patients with psoriatic arthritis is significantly higher than that in patients with psoriasis vulgaris,which can reflect the degree of inflammatory activity of the disease to a certain extent.(6)Psoriatic arthritis may be characterized by rheumatic fever and arthralgia syndrome in the majority of TCM syndromes.TCM syndrome differentiation and treatment combined with western medicine non-steroidal anti-inflammatory drugs,methotrexate,leflunomide,biological agents and other treatments are common in clinic.However,the patient’s condition,treatment compatibility and adverse drug reactions should be fully taken into account. |
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