Introduction. Psoriatic arthritis (PA) is a multi-system inflammatory disorder that involves both musculoskeletal structures (joints, enthesis, tendons) and the skin and nails (psoriasis). Clinical manifestations can be varied from clinically asymptomatic disease to arthritis mutilans and invalidating forms.
Purpose. Identification of renal disease in patients with psoriatic arthritis depending on the degree of activity and severity of skin and joint disease.
Material and Methods. We conducted a retrospective study of 89 patients diagnosed with psoriatic arthritis in the Rheumatology Department of Clinical Emergency Hospital “Sf. Andrei” in Constanta. We collected demographic and behavioural data (age, sex, ethnicity, smoking), clinical and biological elements of joint and skin disease activity (number of painful and swollen joints, joint pain score - VAS, PASI score, ESR, CRP) and evaluation of renal function (serum creatinine, serum uric acid, urinalysis examination for proteinuria and hematuria). Chronic kidney disease was staged by calculating the value of glomerular filtration rate (GFR) with CKD-EPI 2009 equation.
Results. 49 patients have full screening of renal function, especially in disease onset or in case of therapy switch. Proteinuria was found in a significant percentage of patients (32.65%), vary widely between 10-500 mg/dL. Chronic kidney disease (CKD) was commonly found in our patients (42.85%), mostly in women (66.6%). Most cases of CKD were in stage 2 (12.4%). We observed a significant correlation between age and levels of serum creatinine (p = 0.041), caucasians developing more frequently CKD (p <0.0001). The presence of skin psoriasis did not interfere with renal function decline in PA patients, but its severity, measured with PASI score, was correlated with cronic kidney failure stages (p = 0.05) and proteinuria (p = 0.044). The severity of joint pain (TJC, VAS) is directly related to kidney disease (p <0.0001, respectively p = 0.05). The majority of patients with extensive joint erosions also had renal impairment (p = NS) and it can be seen a direct correlation between erosive joint disease and serum creatinine (p = 0.029).
Conclusions: Both the severity of psoriasis and articular disease may be involved in worsening of renal function, probably due to the chronic systemic inflammation and to an aggressive therapy imposed by the disease evolution.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Ogdie A. Schwartzman S. & Husni M.E. (2015). Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol 27(2) 118-126. doi: 10.1097/BOR.0000000000000152.
2. Baker J.F. Krishnan E. Chen L. & Schumacher H.R. (2005). Serum uric acid and cardiovascular disease: recent developments and where do they leave us? Am J Med 118(8) 816-826. doi: 10.1016/j.amjmed.2005.03.043.
3. Bruce I.N. Schentag C.T. & Gladman D.D. (2000). Hyperuricemia in psoriatic arthritis: prevalence and associated features. J Clin Rheumatol 6(1) 6-9..
4. Peluso R. Iervolino S. Vitiello M. Bruner V. Lupoli G. & Di Minno M.N. (2015). Extra-articular manifestations in psoriatic arthritis patients. Clin Rheumatol 34(4) 745-753. doi: 10.1007/s10067-014-2652-9.
5. Casals-Sanchez J.L. Garcia De Yebenes Prous M.J. Descalzo Gallego M.A. Barrio Olmos J.M. Carmona Ortells L. Hernandez Garcia C. & Grupo de Estudio em A.R. II. (2012). Characteristics of patients with spondyloarthritis followed in rheumatology units in Spain. emAR II study. Reumatol Clin 8(3) 107-113. doi: 10.1016/j.reuma.2012.01.006.
6. Alenius G.M. Stegmayr B.G. & Dahlqvist S.R. (2001). Renal abnormalities in a population of patients with psoriatic arthritis. Scand J Rheumatol 30(5) 271-274.
7. Ogdie A. Schwartzman S. Eder L. Maharaj A.B. Zisman D. Raychaudhuri S.P. Reddy S.M. & Husni E. (2014). Comprehensive treatment of psoriatic arthritis: managing comorbidities and extraarticular manifestations. J Rheumatol 41(11) 2315-2322. doi: 10.3899/jrheum.140882.
9. Dervisoglu E. Akturk A.S. Yildiz K. Kiran R. & Yilmaz A. (2012). The spectrum of renal abnormalities in patients with psoriasis. Int Urol Nephrol 44(2) 509-514. doi: 10.1007/s11255-011-9966-1.
10. Chiu H.Y. Huang H.L. Li C.H. Yin Y.J. Chen H.A. Hsu S.T. Lin S.J. Tsai T.F. & Ho S.Y. (2015). Increased risk of glomerulonephritis and chronic kidney disease in relation to the severity of psoriasis concomitant medication and comorbidity: a nationwide population-based cohort study. Br J Dermatol 173(1) 146-154. doi: 10.1111/bjd.13599
11. Rodrigues C.E. Vieira W.P. Bortoluzzo A.B. Goncalves C.R. da Silva J.A. Ximenes A.C. Bertolo M.B. Ribeiro S.L. Keiserman M. Menin R. Skare T.L. Carneiro S. Azevedo V.F. Albuquerque E.N. Bianchi W.A. Bonfiglioli R. Campanholo C. Carvalho H.M. Costa I.P. Duarte A.P. Kohem C.L. Leite N.H. Lima S.A. Meirelles E.S. Pereira I.A. Pinheiro M.M. Polito E. Resende G.G. Rocha F.A. Santiago M.B. Sauma Mde F. Valim V. & Sampaio-Barros P.D. (2012). Low prevalence of renal cardiac pulmonary and neurological extra-articular clinical manifestations in spondyloarthritis: analysis of the Brazilian Registry of Spondyloarthritis. Rev Bras Reumatol 52(3) 375-383..
12. Feldman S.R. Zhao Y. Shi L. Tran M.H. & Lu J. (2015). Economic and comorbidity burden among moderate-to-severe psoriasis patients with comorbid psoriatic arthritis. Arthritis Care Res (Hoboken) 67(5) 708-717. doi: 10.1002/acr.22492
13. Keith D.S. Nichols G.A. Gullion C.M. Brown J.B. & Smith D.H. (2004). Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 164(6) 659-663. doi: 10.1001/archinte.164.6.659.
14. Foley R.N. Murray A.M. Li S. Herzog C.A. McBean A.M. Eggers P.W. & Collins A.J. (2005). Chronic kidney disease and the risk for cardiovascular disease renal replacement and death in the United States Medicare population 1998 to 1999. J Am Soc Nephrol 16(2) 489-495. doi: 10.1681/ASN.2004030203.
15. National Kidney Foundation (2012). KDOQI clinical practice guidelines for glomerulonephritis Kidney Int.; 2(suppl 2):209-233
16. Pana C. Tuta L. Hanzu-Pazara L. & Suta M. (2015) Association between inflammation and renal involvement in psoriatic arthritis Nephrol. Dial. Transplant. 30 (suppl 3): iii519
17. Chi C.C. Wang J. Chen Y.F. Wang S.H. Chen F.L. & Tung T.H. (2015). Risk of incident chronic kidney disease and end-stage renal disease in patients with psoriasis: A nationwide population-based cohort study. J Dermatol Sci 78(3) 232-238. doi: 10.1016/j.jdermsci.2015.03.012