Clinical associations of psoriasis, fibromyalgia, and enthesial-synovial inflammation

Objective. Evaluation of the incidence of fibromyalgia (FM), enthesitis (En), synovitis and tenosynovitis and other rheumatic diseases of the joints among patients with psoriasis (PsO) in the early stages after the onset of musculoskeletal symptoms based on a comprehensive study using clinical laboratory, X-ray and ultrasonographic methods.

Subjects and methods. The study is based on the analysis of survey data from 178 patients with PsO for the period of 2016-2019 years, among which was identified a group of 86 patients who had pain symptoms in the area of joints and tendon-ligamentous apparatus. The duration of the period of musculoskeletal pain in the observed patients did not exceed 6 months. In addition to general clinical and laboratory examination, all patients underwent an investigation for the presence of trigger points and ultrasonography of painful and/or swollen joints, tendons and ligaments on palpation using a linear sensor (frequency of 12-18 MHz) using the Esaote MyLab 50 apparatus and supplemented by Doppler energy study with a pulse frequency of 6.6 MHz.

Results and discussion. Based on the data of a comprehensive examination of the observed patients with PsO, the diagnosis of PsA was established in 29.78 %, osteoarthritis - in 6.18 %, gout -in 3.93 %, fibromyalgia - in 11.24 % of cases. Ultrasonographic signs of En were found in 29.78 %, isolated En was found in 10.67%, a combination of En and synovitis - in 14.04%, a combination of En and tenosynovitis - in 8.99% of patients. Isolated FM was diagnosed in 8.9%, a combination of FM, En and synovitis - in 4.2 % of patients. In patients with FM, in comparison with patients with clinical and ultrasonographic signs, lesions of the scalp, neck and face and palmar-plantar localization were more often observed and, less often, of the upper and lower extremities. Ultrasonographic signs of structural damage to enthesises were observed in 17.4% of patients without clinical and ultrasonographic signs of active EN, which may indicate the possibility of a subclinical course of enthesial inflammation in patients with Ps O.

Conclusion. In the early period of involvement of the musculoskeletal system in patients with PsO, the frequency of PsA was 29.78%, isolated FM - 8.9%, isolated EN - 10.67% of cases. The data on the features of skin lesions in patients with various types of lesions of the musculoskeletal system were obtained.

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