Prevalence and clinical signs of inflammatory back pain in patients with skin psoriasis and axial involvement

BACKGROUND: The incidence of psoriatic arthritis has been increasing in recent years. Moreover the number of severe cases resistant to standard therapy has been increasing as well and leading to a marked deterioration in the quality of life and early disability. There is a need to diagnose the disease at preclinical stages, as well as early therapy and secondary prevention. Therefore, the role of dermatologists in identifying predictors and risk factors for the development and severe course of psoriatic arthritis is increasing. Particularly severe forms of psoriatic arthritis are caused by axial manifestations, which are often clinically asymptomatic in early stage of psoriatic arthritis. Moreover, most often axial manifestations is diagnosed in patients with an already established diagnosis of psoriatic arthritis, and there is practically no data on the prevalence and clinical and instrumental characteristics of axial manifestations in patients with smooth skin psoriasis.

AIM: to assess the prevalence and clinical characteristic of axial manifestations in patients with skin psoriasis using questionnaires, scales and Аssessment of SpondyloArthritis International Society (ASAS) diagnostic criteria.

MATERIALS AND METHODS: The prospective study to assess the prevalence and clinical characteristiс of axial manifestations in patients with skin psoriasis.

RESULTS: The prevalence of axial manifestations in patients with skin psoriasis, according to ASAS criteria, was 36.1%. Early manifestations of axial lesions in patients with skin psoriasis are aching, nagging pain in the back (37.2%) or neck (22.1%), as well as a feeling of stiffness in the back (46.3%) or neck (38.9%). The main risk factors and predictors of the development of psoriatic arthritis were the long duration of skin psoriasis (more than 12 years), pain in any joints, swelling of the fingers, pain/stiffness in the neck, pain/stiffness in the back, pain in the joints at rest/night time, widespread (BSA >18 points), severe (PASI >13 points) process. Having back/neck pain at rest or at night increases the odds of developing inflammatory pain by 132 times and 10 times, respectively, and back/neck stiffness by 10 and 6 times, respectively. Increasing the age of onset of back/neck pain by 1 year increases the chances of developing axial lesions by 1.3 times.

CONCLUSION: There is the first study to identify clinical signs of inflammatory back pain in patient with axial manifestations at early stage of psoriatic arthritis and to determine the prevalence of inflammatory back pain in patients with skin psoriasis and without an established diagnosis of psoriatic arthritis. However, further study of methods for early diagnosis of axial manifestations and other forms of psoriatic arthritis is necessary to optimize treatment and improve the quality of life of patients.