الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Psoriasis is a multisystemic, chronic inflammatory skin condition manifesting with scaly erythematous plaques most commonly affecting extensor surfaces of the elbows and knees, and sometimes the intergluteal and umbilical area, and other parts of the body. It has a prevalence of 2–4% in Western adults, and 20–30% of psoriasis patients will develop psoriatic arthritis (PsA).
PsA is an inflammatory musculoskeletal disease associated with cutaneous psoriasis. It affects men and women almost equally between the ages of 40 and 50 years.
Psoriatic arthritis (PsA) is commonly accompanies plaque psoriasis of the skin with a prevalence as high as 30% among this patient group. The spectrum of psoriatic disease encompasses involvement of the skin, nails, peripheral and axial joints, points of enthesis, and dactylitis. PsA often leads to a marked reduction in patient quality of life due to physical disability from joint damage, fatigue, cardiovascular comorbidity, cerebrovascular disease, as well as type II diabetes mellitus, hyperlipidemia, hypertension, osteoporosis, uveitis, subclinical bowel inflammation and psychologic stress, particularly when left untreated.
The co-occurrence of PsA with these various comorbid diseases often necessitates multidisciplinary care that requires coordination between the rheumatologist and dermatologist, as well as the primary care physician, cardiologist, mental health provider, and other specialists in order to monitor and appropriately formulate an effective treatment plan.
In our study,there was screening for PsA in patients with Psoriasis attending a combined rheum-derm clinic in a tertiary care setting at the Main University Hospital of Alexandria and identify comorbidities and to evaluate the impact of the comorbidity on psoriasis and PsA patients’ health status and outcomes.
Psoriatic patients presenting to the combined derma-rheum clinic were recruited from September 2020 to September 2021. Arthritis was confirmed both clinically and by imaging. All patients were asked to complete the PEST Questionnaire.
All adult patients identified as having PsA fullfing the Classification criteria for Psoriatic Arthritis (CASPAR) criteria and were included.
Patients with history of RA, urogenital, intestinal, HBV and HCV infection, taking oral steroids for non-arthritic/ other medical causes, patients with past history of cancer or hepatitis, patients with other autoimmune diseases other than psoriasis and PsA and patients with osteoarthritis were excluded.
The results of the study revealed that:
• Prevalence of PsA=39.06%, the majority of the studied patients (88.0%) were females.
• It was found that the most common co-morbidity in the studied patients was fatigue(88.0%), followed by depression (64.0%), anxiety (64.0%), obesity (64.0%), fatty liver (40.0%), falls(32.0%), CVD (28.0%), anemia (28.0%), hypertension (24.0%), osteoporosis (16.0%), diabetes (12.0%), hypothyroidism (8.0%) and lastly CKD(4.0%). The most prevalent comorbidities associated with higher score of PSAQol which indicates lower quality of life were anxiety,depression and fatigue.
• The highest clinical features indicating increased risk for psriatic arthritis among PsO patients include :increased psoriasis severity, positive family history, history of fatigue and difficulity with activity of daily living, nail dystrophy and high CRP level.