The prevalence of comorbid and concomitant diseases in psoriatic arthritis patients, data from Russian register

Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis associated with psoriasis (Ps); it belongs to the group of spondyloarthritis and is accompanied by damage to both the spine and peripheral joints, as well as the development of enteritis and dactylitis. In addition to skin and joint damage, PsA has numerous comorbid conditions that are pathogenetically related to the underlying disease, such as inflammatory bowel disease (IBD) and autoimmune eye disease, as well as cardiovascular diseases, obesity and metabolic syndrome, diabetes, osteoporosis, malignancies, mental disorders, and various concomitant diseases. We present data of the prevalence of these pathological conditions among the cohort of PsA patients included in the Russian register.Objective – to study the prevalence of comorbid and concomitant diseases in PsA patients.Materials and methods. The Russian multicenter, observational study with retrospective and prospective data collection of PsA patients included 614 patients with the established diagnosis psoriatic arthritis, corresponding to the CASPAR criteria, from 39 subjects of the Russian Federation, female/male – 331 (54%)/283 (46%). The average age was 45.2±0.52 years, duration of PsA – 5.7±0.27 years, Ps – 15.71±0.56. Duration of observation period: January 2016 – November 26, 2019. The diagnosis of comorbid and concomitant diseases was confirmed by medical specialists in accordance with the ICD-10 code. The analysis of the frequency and structure (%) of these diseases was carried out.Results. The majority of PsA patients had limited Ps: the area of Ps skin lesion (BSA, Basic Surface Area) was less than 3% in 372 (61.5%) patients, BSA from 3% to 10% – in 185 (30.6%), BSA>10% – in 47 (7.8%). Comorbid and concomitant diseases were detected in 297 (48%) of 614 patients. 183 (61.6%) patients had 2 or more diseases in addition to Ps and PsA. Diseases of the circulatory system were detected in 229 (77.1%) PsA patients with comorbid and concomitant diseases (arterial hypertension – in 194 (65.3%), coronary heart disease – in 22 (7.4%)). Diseases of the endocrine system, metabolic disorders were detected in 156 (52.5%) patients with PsA (diabetes mellitus in 44 (14.8%), hyperlipidemia in 44 (14.8%), metabolic syndrome in 36 (12.1%), obesity in 7 (2.4%), and others). Gastrointestinal diseases were observed in 62 (20.9%) patients. Diseases of the biliary system – in 33 (11.1%) patients. Diseases of the musculoskeletal system and connective tissue that are not associated with PsA – in 44 (14.8%). Diseases of the genitourinary system – in 23 (7.7%) patients. Respiratory diseases – in 17 (5.7%) patients. Infectious diseases – in 11 (3.7%). Eye diseases were detected – in 10 (3.4%) patients. Hematological diseases were diagnosed in 6 (2.0%) patients. Depression – in 4 (1.3%) patients.Conclusions. Among 297 patients with PsA with comorbid and concomitant diseases, diseases of the circulatory system are the most common (in 77.1%), less often – diseases of the endocrine system, metabolic disorders (in 52.5%) and diseases of the digestive system (in 32%). Uveitis (2.7%), IBD (1.3%), and depression (1.3%) were rarely detected in our cohort. The majority of patients in the Russian registry had mild forms of Ps (61.5%), and severe Ps (BSA>10%) was observed only in 7.8%. Thus, PsA is associated with a high prevalence of comorbid and concomitant diseases, especially cardiovascular. When choosing a treatment, these diseases should be taken into account. In connection with the new possibilities of therapy, it is necessary to evaluate the potential impact of therapy on patients with comorbid and concomitant diseases in real clinical practice.

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Characteristics of patients with psoriatic arthritis treated with ustekinumab. Evidence from real-life clinical practice

Medical Council ◽

10.21518/2079-701x-2020-21-274-283 ◽

2021 ◽

pp. 274-283

Author(s):

Yu. L. Korsakova ◽

E. Yu. Loginova ◽

E. E. Gubar ◽

T. V. Korotaeva

Keyword(s):

Psoriatic Arthritis ◽

Clinical Laboratory ◽

Real Life ◽

Circulatory System ◽

Latent Tuberculosis ◽

Endocrine System ◽

Gastrointestinal Diseases ◽

Good Tolerability ◽

Viral Hepatitis C ◽

Circulatory System Diseases

Introduction. Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease characterised by involvement of the skin, nail plates, joints, spine and entheses in the inflammatory process. The IL-12/IL-23 inhibitor ustekinumab (UST) is increasingly being used in psoriasis (Ps) and PsA.Aim of the study. To analyze patients with PsA who were under inpatient treatment in the V.A. Nasonova Scientific Research Institute of Rheumatology and Radiology and who were prescribed UST during the period from 2018 to 2020.Material and methods. UST was administered to 17 patients with PsA (9 women and 8 men), mean age was 46.4 ± 11.3 years. Duration of PsA course was 11 ± 10.5 years. Patients underwent clinical, laboratory and instrumental examination, BSA and PASI, DAPSA and BASDAI indices were determined.Results. Patients predominantly had widespread Ps (BSA 18.2 ± 15.9%). Erosive arthritis was present in 94.1% of patients, and sacroiliitis was detected in 100% of patients. PsA activity was high (DAPSA = 44.9 ± 20.9, BASDAI = 6.2 ± 1.5).94% of patients had two or more comorbidities. Circulatory system diseases were observed in 82.4% of patients, liver diseases in 29.5%, gastrointestinal diseases in 47%, endocrine system diseases in 17.6%, viral hepatitis C in 23.5%, latent tuberculosis infection in 17.6%, and joint surgery was performed in 11.2% of patients. The clinical example presented in the article demonstrates good tolerability of UST in a patient with PsA with a number of comorbidities and the possibility to increase the dose of UST from 45 to 90 mg in case of ineffective therapy.Conclusions. The safety profile of UST is good, and it can be administered to patients with cardiovascular diseases, obesity, various infections, including latent tuberculosis, etc.

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Using functional genomics to advance the understanding of psoriatic arthritis

Rheumatology ◽

10.1093/rheumatology/keaa283 ◽

2020 ◽

Vol 59 (11) ◽

pp. 3137-3146

Author(s):

Chenfu Shi ◽

Magnus Rattray ◽

Anne Barton ◽

John Bowes ◽

Gisela Orozco

Keyword(s):

Psoriatic Arthritis ◽

Functional Genomics ◽

Complex Disease ◽

Association Studies ◽

Joint Damage ◽

Underlying Disease ◽

Genome Wide Association Studies ◽

Disease Mechanism ◽

Genome Wide ◽

Functional Mechanisms

Abstract Psoriatic arthritis (PsA) is a complex disease where susceptibility is determined by genetic and environmental risk factors. Clinically, PsA involves inflammation of the joints and the skin, and, if left untreated, results in irreversible joint damage. There is currently no cure and the few treatments available to alleviate symptoms do not work in all patients. Over the past decade, genome-wide association studies (GWAS) have uncovered a large number of disease-associated loci but translating these findings into functional mechanisms and novel targets for therapeutic use is not straightforward. Most variants have been predicted to affect primarily long-range regulatory regions such as enhancers. There is now compelling evidence to support the use of chromatin conformation analysis methods to discover novel genes that can be affected by disease-associated variants. Here, we will review the studies published in the field that have given us a novel understanding of gene regulation in the context of functional genomics and how this relates to the study of PsA and its underlying disease mechanism.

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Polymorbidity in hypertensive patients

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2019-25-2-200-208 ◽

2019 ◽

Vol 25 (2) ◽

pp. 200-208

Author(s):

E. V. Sevostyanova ◽

Yu. A. Nikolaev ◽

I. M. Mitrofanov ◽

V. Ya. Polyakov

Keyword(s):

Circulatory System ◽

Endocrine System ◽

West Siberia ◽

International Classification Of Diseases ◽

High Rate ◽

Age Group ◽

Hypertensive Patients ◽

Classification Of Diseases ◽

Icd 10 ◽

And Gender

Background. Hypertension (HTN) is often combined with other diseases, that significantly complicate its course, worsen the prognosis, interfere with the therapeutic and preventive measures. Therefore, assessing the development and structure of polymorbidity (PM) in hypertension is a relevant issue. Objective. To study the structure and degree of PM in hypertensive patients depending on age and gender. Design and methods. We conducted an analysis of 20 560 case histories of patients with HTN and without HTN (men and women), inhabitants of West Siberia-Novosibirsk region, who underwent examination and treatment at the clinic of the Federal Research Center of Fundamental and Translational Medicine in Novosibirsk. All identified diagnoses (nosological forms and classes according to the International Classification of Diseases of the 10th revision, ICD‑10) were considered. Transnosological PM was assessed by the average number of nosologies corresponding to the three-digit ICD‑10 rubric. Results. An increase in the PM index by 16,8 % was found in HTN patients compared to patients without HTN. Among HTN patients, there was an increase in the incidence of comorbid diseases of the circulatory system (in the 16–39 age group in men — by 46 %, in women — by 42,8 %), the endocrine system, eating disorders and metabolism (in the age group 16–39 years for men — by 19,3 %, for women — by 45,2 %), the musculoskeletal system, urinary system (for men) and neoplasms (for women) compared with patients without HTN. Conclusions. We found a high rate of transnosological PM in HTN patients was found and defined its structure.

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High Prevalence of Metabolic Syndrome and of Insulin Resistance in Psoriatic Arthritis is Associated with the Severity of Underlying Disease

The Journal of Rheumatology ◽

10.3899/jrheum.140021 ◽

2014 ◽

Vol 41 (7) ◽

pp. 1357-1365 ◽

Cited By ~ 75

Author(s):

Muhammad Haroon ◽

Phil Gallagher ◽

Eric Heffernan ◽

Oliver FitzGerald

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Regression Analysis ◽

Psoriatic Arthritis ◽

Multiple Regression Analysis ◽

Multiple Regression ◽

Age Of Onset ◽

Tumor Necrosis Factor Inhibitor ◽

Underlying Disease ◽

Model Assessment

Objective.To investigate the prevalence of metabolic syndrome (MetS) and of insulin resistance (IR) in an ethnically homogeneous cohort of established psoriatic arthritis (PsA), and to identify clinical associations of MetS and IR in patients with PsA.Methods.A cohort of 283 patients with PsA all meeting ClASsification for Psoriatic ARthritis (CASPAR) criteria was included. All underwent detailed skin and rheumatologic assessments, along with cardiovascular risk factor evaluation. IR was defined as an elevated homeostasis model assessment (HOMA-IR) value of > 2.5. Severe PsA was defined as the presence of 1 or more of the PsA-related radiographic damage features (peripheral joint erosions, osteolysis, sacroiliitis), and PsA requiring tumor necrosis factor inhibitor therapy.Results.The demographic and clinical characteristics of the cohort were mean age 54.6 ± 12 years, 52% female, mean PsA duration 19 ± 9 years. MetS was present in 44% of the studied patients (n = 283). On multiple regression analysis, a significant association of MetS was noted with more severe PsA (OR 4.47, p < 0.001), higher smoking pack-years (OR 1.03, p = 0.02), and worse EQ-5D scores (OR 1.28, p = 0.02). Data on IR were available for 263 patients, and among them, the mean HOMA-IR was 1.43 ± 1.09. Forty-one patients (16%) had IR. On multiple regression analysis, a significant association of IR was noted with more severe PsA (OR 3.49, p = 0.03), later psoriasis age of onset (OR 1.07, p = 0.001), and higher body mass index (OR 1.22, p < 0.001).Conclusion.Among patients with PsA, MetS and IR are highly prevalent, and are independently associated with the severity of underlying PsA.

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TRENDS OF MORBIDITY AND CHRONIZATION INDEX IN FEMALE TEENAGERS IN THE RUSSIAN FEDERATION

Clinical Medicine and Pharmacology ◽

10.12737/article_5db94d5fd3e4f8.93824740 ◽

2019 ◽

Vol 5 (3) ◽

pp. 38-44 ◽

Cited By ~ 1

Author(s):

М. Бантьева ◽

M. Bant'eva ◽

Е. Маношкина ◽

E. Manoshkina ◽

В. Кузнецова ◽

...

Keyword(s):

Russian Federation ◽

Metabolic Disorders ◽

Circulatory System ◽

Endocrine System ◽

Young Men ◽

Maximum Increase ◽

Federal Statistical ◽

The Russian Federation ◽

Female Teenagers ◽

First Time

An increase in the incidence of the population, including children and adolescents occurs in recent decades in the Russian Federation. The growth rates of the total and the first time registered incidence of young men aged 15–17 years are analyzed for the period 2000–2017, according to the data of the Federal Statistical Observation. An increase in the overall incidence of young men by 35.8% was detected, for the first time registered incidence — by 35.4%. The maximum increase in overall morbidity is observed in the following classes: neoplasms (up to 2,6 times), diseases of the blood and blood-forming organs (2 times), congen- ital anomalies (malformations) (1,8 times), diseases of the circulatory system (1,7 times), diseases of the musculoskeletal system and connective tissue (1,6 times), diseases of the endocrine system, metabolic disorders (1,5 times). The indicator of “chronicity” of diseases was calculated, based on the data of the total and for the first time registered incidence. With a general growth rate of this indicator 0.3%, there is a significant increase for some of classes of diseases: mental disorders and behavioral disorders (2,1 times), congenital anomalies (malformations) (1,9 times), diseases of the endocrine system, metabolic disorders (1,5 times).

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POS0947 PSORIATIC ARTHRITIS WITH HYPERURICEMIA: MORE PERIPHERAL, DESTRUCTIVE AND CHALLENGING TO TREAT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.308 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 736.2-737

Author(s):

L. Widawski ◽

T. Fabacher ◽

J. E. Gottenberg ◽

L. Spielmann ◽

P. M. Duret ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Univariate Analysis ◽

Joint Destruction ◽

Joint Damage ◽

Serum Urate ◽

Major Adverse Cardiovascular Events ◽

Joint Involvement ◽

Serum Urate Level ◽

Icd 10 ◽

The Impact

Background:Gout and psoriatic arthritis (PsA) can co-exist in the same patient. These 2 diseases seem strongly linked, but the pathophysiological mechanisms of this link have not yet been defined. Hyperuricemia could be an important determinant of PsA1.Objectives:To study the impact of hyperuricemia on clinical presentation, severity and associated comorbidities of PsA.Methods:We conducted a retrospective bicenter case–control study in Strasbourg and Colmar, France. Patients with PsA (according to “L40.5 arthropathic psoriasis” ICD-10 coding) and at least one available serum urate level measurement, were included from 2009 to 2019. Demographic, comorbidities, clinical and radiographic data were collected. Hyperuricemia was defined as serum urate level ≥ 360 µmol/L. We defined “good responders to ongoing PsA treatment” as patients with no outbreak of PsA, biological inflammatory syndrome and therapeutic modification at the last follow-up. Patients with “destructive” disease had one or more erosion(s) seen on standard X-ray, ultrasonography, MRI or TDM.Results:We included 242 patients. 73 (30.2%) had hyperuricemia and 15 (6.2%) met criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more often male (72.6% vs. 39.1%, p = 1.6x10-06), had higher BMI (30.9 vs. 28.7 kg/m2, p = 0.015) and had more comorbidities (Charlson Comorbidity Index: 2.6 vs. 1.8, p = 0.005). In hyperuricemic versus normo-uricemic patients, PsA started at an older age (47.5 vs 43 years, p = 0.016); PsA was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs. 37.4%, p = 0.032). Median uricemia was higher in patients with destructive than non-destructive PsA (321 vs 288.8 μmol/l, p = 0.0038), and hyperuricemia was more frequent with than without joint destruction (37.6% vs 25.8%, p = 0.047). The multivariate analysis confirmed hyperuricemia associated with peripheral joint involvement (OR 2.98, p = 0.025) and less good response to PsA treatment (OR 0.35, p = 0.024).Figure 1.Description of normo- and hyperuricemic psoriatic arthritisCRF: moderate to severe chronic renal failure. MACEs: major adverse cardiovascular events. HBP: high blood pressure. MetS: metabolic syndrome. PsA: psoriatic arthritisConclusion:Patients with hyperuricemic PsA have less good response to PsA treatment than those with normo-uricemia and more peripheral and destructive joint damage. Recognition of PsA in which hyperuricemia would play an aggravating role could modify the management. This would justify a diagnostic reassessment in case of doubt, the possible introduction of hypouricemic treatment and the careful use of NSAIDs in the context of multiple morbidities.References:[1]Felten R, Duret P-M, Gottenberg J-E, Spielmann L, Messer L. At the crossroads of gout and psoriatic arthritis: « psout ». Clin Rheumatol. Febr 2020.Acknowledgements:We thank all participating patients. We also thank the medical secretaries for their help with the ICD-10 extraction, and Dr Thomas Lavaux for helping with serum urate tests at Strasbourg University Hospital.Disclosure of Interests:None declared

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COMPARISON OF THE STRUCTURE OF MORBIDITY BY THE RESULTS OF PREVENTIVE MEDICAL EXAMINATIONS AND OF PROFESSIONAL MEDICAL EXAMINATIONS

10.31089/978-5-6042929-2-1-2021-1-110-113 ◽

2021 ◽

Author(s):

T.V. Veselova ◽

◽

D.V. Chentsov ◽

Keyword(s):

Musculoskeletal System ◽

Digestive System ◽

Metabolic Disorders ◽

Circulatory System ◽

Endocrine System ◽

The Third ◽

Different Types ◽

Group 2 ◽

Medical Examinations ◽

Group 1

Abstract. The aim of the study was to compare the structure of morbidity revealed by the results of preventive medical examination with the structure of morbidity revealed by the results professional examination. Group 1 included 146 999 men aged 20-60, who underwent professional examination, group 2 - 424 770 men aged 21-60 who had undergone preventive medical examinations. In both groups, diseases of the circulatory system are in first place in terms of detection (group 1 – 24,37%, 2 – 41,41%). In second place in the course of preventive medical examinations are diseases of the endocrine system, nutritional disorders and metabolic disorders (16,94%), and in case of professional examination - diseases of the eye and its adnexa (15,46%). The third place in the course of professional examination is - diseases of the respiratory system (14,65%), with preventive medical examinations - diseases of the digestive system (9.83%). Since the diseases of the musculoskeletal system are not separately taken into account during the clinical examination, they are classified in the category «Other diseases». However, it should be noted that during the professional examination, this group of diseases is detected in 21% of cases. Taking into account the figures obtained for the detection of diseases of the musculoskeletal system, it seems important to focus the attention of occupational medicine specialists on this in order to develop and introduce measures to improve the health of the musculoskeletal system into corporate programs. These differences are associated with a different volume of research conducted for different types of medical examinations, as well as with the fact that a number of diseases of the circulatory system and the endocrine system are a contraindication for employment in contact with harmful labor factors. A higher level of detection of infectious pathology and neoplasms in case of professional examination requires a more thorough analysis.

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