A study on clinico-immunological profile and treatment outcome of psoriatic arthritis

Ragunathan, R (2013) A study on clinico-immunological profile and treatment outcome of psoriatic arthritis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Robert Willan, the British dermatologist described psoriasis as an independent disease in 18-th century. The French Physician Baron Jean Louis Alibert first described the association between the psoriasis and psoriatic arthritis in 1918. Initial clinical features of PsA were described first by Wright V et al in 1959 and along with Moll they published the first classification criteria in 1973. Psoriatic arthritis was included as a distinct arthritis in the classification of rheumatic diseases in 1964 by American Rheumatism Association. Psoriatic arthritis is one of the diseases of SpA family and defined as inflammatory arthritis occurring in patients with psoriasis and negative test for rheumatoid factor commonly. It is a progressive and disabling disease and often associated with increased morbidity. According to one prospective study by Kane D [et. Al.], psoriatic arthritis constituted 13% of new patients attending early arthritis clinic and progressive erosive change occurs in around 50% of patients in the first few years. The exact prevalence of psoriasis and psoriatic arthritis is not known and the prevalence of psoriasis in general population is around 1 to 3 %. The incidence of arthritis in patients with psoriasis is between 5 and 7 %. There are only few studies in psoriatic arthritis in India especially the immunological profile like anti -CCP antibodies in psoriatic arthritis, correlation of skin and arthritis. So we took this study to correlate the skin disease and arthritis as well as to study the immunological profile of patients with psoriatic arthritis. AIMS AND OBJECTIVES: 1) To study the clinical profile of patients with psoriatic arthritis. 2) To assess the correlation between skin disease and arthritis in patients with psoriatic arthritis. 3) To study the immunological profile of patients with psoriatic arthritis. 4) To assess the outcome of patients with psoriatic arthritis. MATERIALS AND METHODS: PLACE OF THE STUDY: Department of Rheumatology, Rajiv Gandhi Government General Hospital & Madras Medical College, Chennai-3. DESIGN OF THE STUDY: Prospective analytical study. PERIOD OF THE STUDY: 2 years -From January 2011 to December 2012. ETHICS COMMITTEE APPROVAL: Approval from hospital ethics committee was obtained before starting the study. CONSENT: A clearly written informed consent on their own language was taken from all patients and from their parents in case juvenile PsA. INCLUSION CRITERIA: 1) Adults who are fulfilling CASPAR classificat ion criteria for psoriatic arthritis. 2) Children fulfilling ILAR criteria for Juvenile psoriatic arthritis. EXCLUSION CRITERIA: 1) Reactive arthritis, 2) Rheumatiod arthritis, 3) Enteropathic arthritis, 4) Crystal arthritides. RESULTS: Totally 110 patients were included for the study over two years period. Out of these 61 (55.5 %) were males and 49 (44.5 %) were females. Lowest age of the patient in our study was 9 years and highest was 70 years. Mean age of the patient was 39.55 years. Majority of the patients were in between 3rd to 5th decade. CONCLUSION: 1) The mean age of the patients in our study was 39.5 years. 2) Slight male preponderance was observed (1.2 : 1 ). 3) Skin disease preceding arthritis was noted in majority of patients (56%) and simultaneous onset was found in 19 % of patients. 4) Onset of arthritis after 10 years of psoriasis is uncommon (9%). 5) Psoriasis vulgaris was the commonest skin pattern and symmetric polyarthritis was the commonest subtype of arthritis noted in our study. 6) The prevalence of ANA, anti-CCP and RF positivity in our patients were 14.2%, 9.7 %, 6.3% respectively. 7) Anterior uveitis was observed in3.6 % of our patients. 8) Positive correlation between skin and joint disease activity was noticed although statistically not significant. 9) Anti-CCP positive psoriatic arthritis patients had higher number swollen, tender joints and more radiographic damage. 10) At the end of one year follow-up, 57.5% of patients showed PsARC improvement response. 11) At the end of two years follow-up, 48.7% of patients showed PsARC response and 2.7% showed Minimal Disease Activity response.

Item Type: Thesis (Masters)
Uncontrolled Keywords: psoriatic arthritis, clinico-immunological profile, treatment outcome.
Subjects: MEDICAL > Rheumatology
Depositing User: Kambaraman B
Date Deposited: 13 Jan 2020 08:51
Last Modified: 13 Jan 2020 09:26
URI: http://repository-tnmgrmu.ac.in/id/eprint/11816

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