الفهرس 
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Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory immune-mediated disease with various musculoskeletal presentations. It occurs in almost 30% of psoriasis patients with arthritis preceding skin lesions in almost 20% of patients. Enthesitis is a main feature of PsA and can be the only feature in early cases for years before symptoms start. US is an important diagnostic tool for enthesitis and is used to detect subclinical cases. PsA is highly associated with many comorbidities that can affect the function of patients and their quality of life.
Autoimmune thyroid disease (AITD) is a common autoimmune disease that can be associated with other autoimmune diseases increasing their disease burden. It can result in subclinical hypothyroidism and hypothyroidism. The presence of AITD and subclinical hypothyroidism in psoriatic disease have been associated with fibromyalgia like symptoms, increased PsA disease activity, pain, and worsening of function. Subclinical hypothyroidism has been associated with an increased risk of cardiovascular diseases.
CXCL10 is a chemokine secreted in response to IFN-γ in T-helper 1-mediated immune diseases such as psoriatic disease and AITD, so it may have a role in their association.
Our study was designed to assess the association between AITD and psoriatic disease and to measure the serum level of CXCL10 to assess its role in their association.
This study was conducted on 45 adult Egyptian female patients with psoriatic disease who were classified into equal 3 groups of PsA, subclinical PsA, and psoriasis that were matched in age, psoriasis duration, body mass index, and comorbidities. The patients in the PsA group were classified according to CASPAR criteria while the patients in the subclinical PsA and the psoriasis groups were classified by global sonographic enthesitis score; MASEI with a cut-off value ≥18.
All the patients were subjected to a full medical history with an emphasis on health assessment questionnaire (HAQ), a thorough clinical examination with an emphasis on psoriasis disease activity by Psoriasis Area Severity Index (PASI), enthesitis clinical assessment by Leeds Enthesitis Index (LEI), PsA disease activity by DAPSA, laboratory investigations including CBC, ESR, CRP, serum uric acid, glycated hemoglobin, thyroid profile including TSH, FT3, FT4, thyroid peroxidase antibody (TPO-Ab), and thyroglobulin antibody (Tg-Ab), and serum CXCL10 and radiological investigations including thyroid gland US.
Patients in the PsA group had higher HAQ scores compared to those in the other 2 groups with a high statistical significant difference. Patients in the PsA group had higher LEI compared to those in the psoriasis group with a high statistical significant difference. Patients in the PsA group had higher LEI compared to those in the subclinical PsA group with a statistical significant difference. Patients in the subclinical PsA group had higher LEI compared to those in the psoriasis group with a statistical significant difference.
Patients in the PsA group had lower hemoglobin levels compared to those in the other 2 groups with a high statistical difference. Patients in the PsA group had lower platelets count compared to the other 2 groups with a statistical significant difference. Patients in the PsA and the subclinical PsA groups had higher ESR and CRP levels compared to those in the psoriasis group with high statistical significant differences.
The study revealed:
• In all patients with psoriatic disease, 20% had subclinical hypothyroidism, 46.67% had TPO-Ab positivity, and 26.67% had Tg-Ab positivity. These percentages were higher in the PsA group compared to the subclinical PsA group. In the PsA group, 33.3% had subclinical hypothyroidism, 80% had positive TPO-Ab, and 46.7% had positive Tg-Ab. In the subclinical PsA group, 26.7% had subclinical hypothyroidism, 60% had positive TPO-Ab, and 33.3% had positive Tg-Ab. While in the psoriasis group, 100% of the patients were within the normal range of serum levels of thyroid hormones with negative TPO and Tg Abs. Patients in the PsA group had higher TPO-Ab level compared to those in the psoriasis group with a high statistical significant difference and patients in the subclinical PsA group had higher TPO-Ab level compared to those in the psoriasis group with a statistical significant difference. Patients in the PsA group had lower FT3 levels compared to those in the psoriasis group with a statistical significant difference.
• Thyroiditis features in US including non-homogenous coarse echopattern, multiple fibrous strands, multiple small nodules, and increased vascularity were present in 26.7% of the patients in the PsA group and 20% of the patients in the subclinical PsA group with no statistical significant difference on comparing the three groups.
• Patients in the PsA group had higher CXCL10 levels compared to those in the other 2 groups with a high statistical significant difference.
• Serum CXCL10 can detect the possibility of PsA development in the subclinical PsA patients with a cut-off point >151 ng/l with sensitivity 93.33%, specificity 86.67%, positive predictive value 87.5, and negative predictive value 92.9, as well as in the psoriasis patients with a cut-off point >95.5 ng/l with sensitivity, and specificity 93.33%, positive predictive value 85.7, and negative predictive value 60.9.
• A statistical significant negative correlation between TPO-Ab and the patient’s age in the PsA group and a statistical significant positive correlation between TPO-Ab and the patient’s age in the subclinical PsA group. A high statistical significant positive correlation between TPO-Ab and the duration of psoriasis in the subclinical PsA group.
• A statistical significant correlation between FT3 and the presence of hypertension in the psoriasis group.
• A statistical significant correlation between sonographic thyroiditis and the presence of diabetes mellitus in the subclinical PsA group.
• A statistical significant correlation between TPO-Ab and BMI ≥30 in the psoriasis group.
• A high statistical significant negative correlation between FT4 and LEI in the subclinical PsA group.
• A statistical significant correlation between TPO-Ab and DAPSA in the PsA group.
• A high statistical significant positive correlation between TPO-Ab and MASEI and statistical significant positive correlations between each of FT3 and Tg-Ab and MASEI in the subclinical PsA group.
• A statistical significant correlation between FT4 and PASI in the subclinical PsA group.
• A statistical significant positive correlation between TPO-Ab and ESR in the subclinical PsA group and a high statistical significant positive correlation between Tg-Ab and CRP in the psoriasis group.
• A high statistical significant positive correlation between TSH and serum uric acid in the PsA group.
• A statistical significant positive correlation between Tg-Ab and TSH and between FT3 and FT4 in the PsA group. Also, a high statistical significant positive correlation between Tg-Ab and TSH in the subclinical PsA group.
• A high statistical significant correlation between TPO-Ab and sonographic thyroiditis and a statistical significant correlation between each of TSH and Tg-Ab and sonographic thyroiditis in the PsA group.
• A statistical significant correlation between TSH and sonographic thyroiditis in the subclinical PsA group.
• High statistical significant positive correlations between the serum level of CXCL10 and MASEI in each of the subclinical PsA and the psoriasis groups.
• A statistical significant correlation between the serum level of CXCL10 and PASI in the subclinical PsA group.
• In the PsA group, there was a high statistical significant positive correlation between serum CXCL10 and TPO-Ab levels, a statistical significant positive correlation between serum CXCL10 and Tg-Ab levels, and a high statistical significant correlation between serum level of CXCL10 and sonographic thyroiditis.
• In the subclinical PsA, there were high statistical significant positive correlations between serum CXCL10 and each of TSH and TPO-Ab levels and statistical significant positive correlations between serum CXCL10 and each of Tg-Ab and FT3 levels.