CLINICAL, LABORATORY AND IMMUNOGENETIC ASPECTS OF POSTTRAUMATIC PSORIATIC-ARTHRITIS - A STUDY OF 25 PATIENTS

Objective In a previous study we demonstrated that the prevalence of t rauma preceding arthritis was higher in patients with psoriatic arthri tis (PsA) than in patients with rheumatoid arthritis (RA) or ankylosin g spondylitis (AS); of 300 consecutive patients with PsA, 25 (8%) had a history of trauma before (< 3 months) the onset of the disease. The present study was carried out to characterize the clinical, laboratory and immunogenetic profiles of post-traumatic (PT)-PsA. Patients and m ethods The clinical and laboratory features of 25 patients with PT-PsA were studied at onset (first 6 months) and after a follow-up period o f 1-7 years, and were compared with those of 275 PsA patients without any history of trauma (nonPT-PsA). HLA typing was pet-formed in PT-PsA patients, and synovial fluid (SF) analysis, including interleukin (IL )-1 and IL-6 determinations, was carried out in 12 subjects with PT-Ps A and in 32 with nonPT-PsA. Results No differences were observed betwe en PT-PsA and nonPT-PsA patients with regard to their clinical evoluti on. ESR (p < 0.0001) and CRP (p = 0.005) were higher in PT-PsA than in nonPT-PsA patients at disease onset but not after follow-up. No diffe rences were found in the other blood indices. SF analysis revealed hig her IL-6 levels in PT-PsA than in nonPT-PsA patients (p < 0.0005). Con clusion Our study demonstrates that the prevalence of trauma preceding arthritis is higher in PsA than in RA or AS. Clinical and laboratory findings in patients with PT-PsA differed from those with nonPT-PsA on ly at disease onset (first six months), however; showing an abrupt cli nical presentation and a more acute phase response. This pattern may b e related to the higher levels of IL-6 found in the SF of PT-PsA than in nonPT-PsA patients. However; during the follow-up period the two gr oups became indistinguishable, and no difference was observed between PT-PsA and nonPT-PsA regarding the evolution of the disease.