Analysis of clinical characteristics and risk factors for disease progression of psoriatic arthritis based on real-world data

WANG Ziyuan; YANG Yang; LI Bing; YU Chen; SHAO Shuai; WANG Gang

doi:10.13276/j.issn.2097-1656.2025.08.005

Abstract：Objective To construct a retrospective database of psoriatic arthritis(PsA),elucidate the clinical characteristics and musculoskeletal ultrasound(MSUS)manifestations of patients with clinical and subclinical PsA,analyze and compare the internal heterogeneity of PsA patients,and identify the independent risk factors driving progression from subclinical PsA to clinical PsA based on above data,so as to provide evidence-based support for precise stratified management and early intervention for PsA.Methods A retrospective database was constructed based on the PsA patients treated in the Department of Dermatology,Xijing Hospital,Air Force Medical University from January 1,2020 to December 31,2023.Subtype diagnoses were conducted according to the criteria of the European League Against Rheumatism:①subclinical PsA group(psoriasis patients with joint pain and/or imaging evidence of synovitis/enthesitis,but without clinical synovitis);②clinical PsA group(psoriasis patients with clinical synovitis).The diagnostic criteria for clinical synovitis were based on the simultaneous manifestations of swelling and pain of the joints,along with imaging or other evidence of synovitis.A total of 227 PsA patients meeting the inclusion and exclusion criteria were included,with 75 in the subclinical PsA group and 152 in the clinical PsA group.The demographic and clinical characteristics and MSUS manifestations of clinical and subclinical PsA patients were described and compared to analyze the differences between the groups.Based on the demographic information and clinical characteristics,the subclinical and clinical PsA cohorts were compared and multivariable logistic regression models were fitted to identify the risk factors for PsA progression.The calibration and goodness of fit of models were validated through Hosmer-Lemeshow(HL)test and likelihood ratio test(LRT).Results Demographic and clinical characteristics were different between clinical PsA and subclinical PsA patients.The incidence of nail involvement was higher in the clinical PsA group(72.37％vs 58.67％,P=0.038).The proportion of patients with an age of onset ≤ 30 years in the subclinical PsA group was lower than that in the clinical PsA group(45.33％vs 65.79％,P=0.003).There were differences in MSUS manifestations between subclinical PsA and clinical PsA patients.The incidence of joint effusion in subclinical PsA patients was similar to that in clinical PsA patients(61.33％vs 66.45％,P=0.448),while the proportions of inflammatory manifestations such as synovial thickening(5.33％vs 54.61％,P＜0.001),increased synovial blood flow signals(1.33％vs 24.34％,P＜0.001),and entheseal erosion(4.00％vs 30.26％,P＜0.001)were significantly lower in the subclinical PsA group compared to the clinical PsA group.Multivariate analyses revealed the risk factors for progression from subclinical PsA to clinical PsA.In the logistic regression model,female gender(OR=2.966,95％CI=1.477-5.955,P=0.002),nail involvement(especially nail bed thickening and nail plate pitting)(OR=1.921,95％CI=1.010-3.655,P=0.047),and age at onset≤30 years(OR=2.796,95％CI=1.486-5.260,P=0.001)were independent risk factors for PsA progression.The model showed HL test＞0.05,and LRT test＜0.001,indicating good calibration and goodness of fit.Conclusion The cohort analysis identifies key risk factors for the progression from subclinical PsA to clinical PsA,including demographic characteristics and clinical manifestations such as female gender,nail involvement and age at onset ≤30 years.Meanwhile,MSUS revealed comparable rates of joint effusion between the two groups,while synovitis and enthesitis were less prevalent in subclinical PsA.These findings provide a theoretical basis for establishing a stratified management system for PsA patients.For early PsA patients with the aforementioned risk factors,it is essential to enhance regular joint assessments and conduct dynamic monitoring through imaging examinations for timely individual intervention,which will aid in improving the prognosis of PsA patients.