Clinical characteristics of 17 patients with psoriatic arthritis sine psoriasis

WANG Yan; DAI Sheng-ming; WANG Qian

doi:10.19538/j.nk2025090108

Abstract：Objective To investigate the clinical characteristics of patients with psoriatic arthritis(PsA)sine psoriasis and disease features.Methods A retrospective study was conducted.Totally 17 patients with PsA sine psoriasis were recruited,who received consecutive treatment in Shanghai Sixth People's Hospital from June 2023 to October 2024.The demographic characteristics,clinical manifestations,laboratory results,delayed time to diagnosis and treatment,treatment regimens,and clinical outcomes were analyzed.Results The study included 17 patients with PsA sine psoriasis,with an average age of(51.4±16.6)years and a male-to-female ratio of 11∶6.The median time from onset to diagnosis was 3 years(IQR:2-10).Nine patients(52.9％)were misdiagnosed as rheumatoid arthritis,2(11.8％)as gout,2(11.8％)as osteoarthritis,and 4(23.5％)as undifferentiated arthritis.Among them,3 patients(17.6％)reported a family history of psoriasis,while 16(94.1％)displayed psoriatic nail lesion.Peripheral joint involvement was observed in all patients,with axial joint involvement in 7(41.2％),dactylitis in 14(82.4％),and enthesitis in 7(41.2％).Joint deformities and limited mobility were noted in 5 patients(29.4％).Laboratory findings revealed elevated erythrocyte sedimentation rate(ESR)in 15 patients(88.2％)and elevated high-sensitive C-reactive protein(CRP)level in 12(70.6％).Human leukocyte antigen-B27(HLA-B27)was positive in 3 patients(17.6％),and hyperuricemia was present in 4(23.5％).Joint ultrasound examination revealed synovitis in 11 patients(64.7％),tenosynovitis in 9 patients(52.9％),enthesitis in 7 patients(41.2％),double contour sign in 2 patients(11.8％),osteophyte formation in 7 patients(41.2％),and bone erosion-like changes in 5 patients(29.4％).Conclusion Patients with PsA sine psoriasis commonly present with dactylitis and enthesitis.Ultrasonography is prone to demonstrate manifestations such as synovitis,tenosynovitis,and enthesitis.The patients may experience prolonged diagnosis,and there are high rates of missed diagnosis and misdiagnosis.The patients are likely to have psoriatic nail damage and a family history of psoriasis.