Article
Are patients with psoriatic arthritis at a higher risk for developing depressive symptoms compared to psoriatic patients without arthritis?
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Published: | February 5, 2019 |
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Background: Psoriatic arthritis (PsA) is an inflammatory rheumatic disease affecting approximately 30% of psoriasis patients. The clinical presentation is heterogeneous and may include peripheral as well as axial joint involvement, dactylitis and enthesitis. If left untreated, PsA may lead to a mutilating destruction of joints associated with a high rate of disability. Furthermore, psoriasis as well as psoriatic arthritis have been associated with depression, which also constitutes a major cause for morbidity.
Methods: A questionnaire-based screening tool (PEST, FFbH, WHOQOL-BREF, Phq9, GHQ-12) is used to assess psoriasis as well as psoriatic arthritis patients for signs of arthritis as well as comorbidities and quality of life.
Results: We have assessed 100 psoriasis patients as well as 100 patients with confirmed psoriatic arthritis for signs of psoriatic arthritis, depression and quality of life. 79% of questioned psoriasis patients reported joint problems. Out of these, all patients reported peripheral joint problems (on average 4.58 joint regions affected), while 34% additionally had axial involvement. 42% of patients reached a score of 3 or more points in the PEST symptom check, with therefore suspicion of psoriatic arthritis. 19% of patients with confirmed psoriatic arthritis had a clinically relevant functional impairment in daily life as assessed by FFbH questionnaire (score <60%) compared to 4% of psoriasis patients. Quality of life was assessed with the help of the WHOQOL-BREF questionnaire. Psoriatic arthritis patients scored significantly lower in the physical health domain than patients with psoriasis only (p 0.0001). Furthermore, patients with psoriatic arthritis had a significantly lower score in the social relationship domain (p<0.05), results for the psychological wellbeing and environment domains were comparable. Psoriasis patients reached on average 6.5 points compared to 7.9 points in PsA patients in the Phq9 questionnaire, both equalling mild depressive symptoms. 25%, respectively 30% of patients had moderate to severe depressive symptoms.
Conclusion: Our data confirm an association of psoriasis, depressive symptoms and reduced quality of life, which was significantly stronger in patients with confirmed psoriatic arthritis.