Prevalence of psoriatic arthritis in psoriasis patients according to newer classification criteria.

The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to Classification of Psoriatic Arthritis (CASPAR) criteria, Assessment of Spondyloarthritis International Society (ASAS) peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % had nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was of 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs 10 years, p = 0.02), and a higher frequency of nail involvement (88.2 vs 49.4 %, p = 0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs 1.2 %, p = 0.0006 and 80 vs 16.7 %, p = 0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding a proper classification.

Work status among patients with ankylosing spondylitis in Argentina.

OBJECTIVE: To evaluate work status and its determinants among ankylosing spondylitis (AS) patients in our country. MATERIALS AND METHODS: We carried out a case-control study, including AS patients older than 16-year-old. Demographic, socioeconomic, and employment data were collected. Individuals from the general population matched by age, sex, and socioeconomic level served as the control group. Functional capacity was evaluated by bath ankylosing spondylitis functional index (BASFI) and health assessment questionnaire (HAQ-S) and disease activity by bath ankylosing spondylitis disease activity index (BASDAI). All patients completed quality of life (ASQol), depression (CES-D), and fatigue (FSS)-validated questionnaires. RESULTS: Sixty-four patients with AS (57 men) and 93 controls (83 men) were included. The frequency of retirement due to age was comparable in both groups, however, a significantly larger number of patients with AS were retired due to disability: 6 (9.4%) versus 0 (P = 0.004). Patients with AS had a significantly greater number of comorbidities than controls (78.7% vs. 31.5%, P = 1 x 10(-8)). Sixteen patients (26.2%) were unemployed compared with 4 controls (4.5%) (P = 0.001). Permanence at work was significantly lower in patients (median age 58, SD 54-61 years) versus controls (median age 66, SD 63-68 years) (log Rank P = 0.001). There were less full-time workers (71% vs. 87%, P = 0.03) and higher number of sick leave days (6.56 +/- 13 vs. 2.13 +/- 4.5, P = 0.01) in AS patients than controls. Unemployed patients had significantly worst quality of life, disease activity, and depression scores than employed patients. In the multivariate analysis, the primary variable associated to unemployment was depression [Odds Ratio (OR): 20, 95% confidence interval (CI), 1.69-258, P = 0.001] followed by disease activity (OR: 1.05, 95% CI, 1-1.1, P = 0.04) and age (OR: 1.1, 95% CI, 1.02-1.21, P = 0.01) as secondary variables. CONCLUSIONS: The frequency of work disability among our patients with AS was significantly higher than in age, sex, and socioeconomic matched population. The main variable associated with work disability and unemployment was depression. Whether this factor is contributing to or is a result of disability is not known.