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Clinical and epidemiological characterization of psoriasis and psoriatic arthritis in a multidisciplinary assessment model

Alejandra Lopez R, Karla Macias G, Marcela Cerda E & Pamela Sandoval M

Background: Presentation and clinical course in Psoriasis are heterogeneous. A multidisciplinary assessment model was designed, under a procedure manual for five specialties related to disease manifestations: dermatology, rheumatology, internal medicine, nutrition and psychiatry, to evaluate at the same time and place, patients with psoriasis, to determine the frequency of psoriatic arthritis and other comorbidities in patients with psoriasis, as well as performing a clinical and epidemiological characterization of psoriasis and psoriatic arthritis in patients seeking medical consultation in a multidisciplinary assessment model in Guadalajara Jalisco, Mexico.

Methods and Findings: A prospective study that included patients that attended a multidisciplinary psoriasis clinic from August 2016 to February 2018. Patient triage and evaluation of psoriasis or psoriatic arthritis was performed either by a rheumatologist or a dermatologist at an appointment prior to enrollment. If a clinical, radiological or histological criterion was met, patient was scheduled to an appointment to the multidisciplinary clinic. Fifty three patients were included. Median age was 42 years old and 62.3% were female. Family history of psoriasis was found in 26.4% of population and 19.4% had spondyloarthropathy family history. Most common comorbidities found were overweight and obesity 66%, metabolic syndrome in 35.8%, diabetes mellitus in 15.1%, dyslipidemia in 22.6%, hypertension in 13.1% and fatty liver in 3.8%. Affective assessment was performed and 49.1% met criteria for anxiety. Psoriasis was found in 96.2% and 56.6% in nails. PASI was moderate to severe in 49.1%. Psoriatic arthritis in 58.5% of patients that met CASPAR criteria. Axial disease was present in 51.6%, peripheral joint disease in 71% and in 13.2% both. Enthesitis was present in 54.8% and 16.1% had dactylitis. DAS28 was performed and showed 45.2% with severe activity. Total number of subjects with peripheral disease did not met criteria for remission measured by DAS28 or MDA.

Conclusions: We found that nearly half of the patients have moderate to severe form of psoriasis. The number of patients with psoriatic arthritis was higher than expected with both axial and peripheral manifestations. We have found a high proportion of patients with comorbidities such as metabolic syndrome, diabetes mellitus, hypertension, dyslipidemia and obesity. We observed a high frequency of psychiatric illness like depression and anxiety. The limitations of our study are the small sample to highlight if comorbidities had an impact on the severity of skin and joint disease. This multidisciplinary model has identified psoriasis as a disease with an unpredictable course, which requires several evaluations by a multidisciplinary model, with a group of experts beyond Dermatologist and Rheumatologist.