Psoriazis Hastalarında Kas-İskelet Sisteminin Elektrofizyolojik ve Ultrasonografik Olarak Değerlendirilmesi

Abstract

Psoriasis is a chronic, relapsing, inflammatory dermatose which is accompanied by psoriatic arthritis (PsA) in 5-30% of the cases. Peripheral neuropathy is a term that can be used for almost every condition that affects peripheral nervous system. In most of the rheumatic conditions, polyneuropathy caused by pathogenesis and by the involvement of the disease or by the treatments, is reported. The main aim of this study was to see enthesopathy frequency using Glasgow Ultrasound Enthesitis Scoring Scale (GUESS) and to define the relationship between enthesopathy and clinical parameters as well as to find out the frequency of peripheral neuropathy in psoriasis patients by nerve conduction studies and the relation between clinical parameters. 74 psoriasis patients' Achilles, plantar aponeurosis, quadriceps, proximal and distal patellar entheses were evaluated by ultrasonography (USG) using GUESS. Sensory and motor nerve conduction studies in median and ulnar nerve of both upper extremities, motor nerve conduction study of peroneal and tibial nerves in lower right extremity and sensory conduction study on right sural nerve was performed in 25 psoriasis patients. In 172 of 730 (23,56%) entheses, USG found signs indicative of enthesopathy. Enthesopathy was statistically significantly more frequent in the cases with nail involvement compared to cases without nail involvement (p = 0,004). There was no statistically significant difference of enthesopathy frequency between symptomatic and asymptomatic patients (p>0,05). 7 (28%) of 25 patients had a pathology in nerve conduction studies. Bilateral ulnar and right tibial nerve distal motor latencies were shown to get longer (p = 0,001, p = 0,01, p = 0,019) whereas left ulnar nerve sensory conduction velocity gets slower (p = 0,033) with increasing GUESS scores. Nail involvement and enthesopathy is closely related. The patients with nail involvement should be reviewed for enthesopathy and screened for PsA development. Enthesial anomalies can also be seen in psoriasis patients without articular symptoms. Wide and long-term studies are necessary to research the importance of subclinical enthesopathy in the early diagnosis of PsA. Peripheral nerve dysfunction was frequently diagnosed in psoriasis patients and the possibility vii of a relationship between enthesopathy and peripheral nerve dysfunction was found. In order to clarify such relations, controlled studies with a wider patient population are necessary.