Assessment of spondyloarthropathic changes in psoriasis patients with no identified locomotor system involvement by physical examination and direct radiography

Eighty-one psoriasis patients with nail and skin involvement who were under monitorization in the Dermatology Department and determined to have no psoriatic arthritis according to the Classification of Psoriatic Arthritis Group (CASPAR) criteria, were enrolled in our study. All the patients received dermatological evaluation and locomotor system examination. Each patient was assessed for nail involvement by NAPSI, for skin involvement by PASI, and for enthesopathy by MASES and Leeds enthesitis index. Demographic data of the patients were recorded. AP-lateral lumbar and spot sacroiliac joint radiographs as well as lateral X-rays of both feet were routinely performed. In cases displaying a tenderness, presence of lesions was verified by radiography of the related area.Examination of the locomotor system revealed clinical and radiographic findings that were consistent with enthesopathy in 51.85% of the cases. There was a strong correlation between the patients with nail involvement and those with enthesopathy. Among cases with enthesopathy, the onset age and duration of the disease were found to be higher than among those with no enthesopathy. There was a marked reduction in the lumbar flexibility and chest expansion.Psoriasis is a common public health problem. One fourth of cases have been reported to demonstrate symptomatic joint involvement. Among our study population which was comprised of psoriasis cases with no previously diagnosed arthropathy, insignificant local enthesopathy symptoms that are generally ignored by patients, were more common than expected. Probably, enthesopathic process is triggered shortly before the onset of cutaneous involvement among majority of the cases, after which some patients demonstrate evident arthropathy. Because of the association between enthesopathic involvement and psoriasis, a multidisciplinary approach should be taken to monitor the patients.