Procena prisustva entezitisa kod bolesnika sa psorijazom: povezanost sa kliničkim karakteristikama, rezultatima screening upitnika i kvalitetom života – ehosonografska studija
Sažetak
Uvod/Cilj. Iako je često asimptomatski, entezitis može biti sastavni deo širokog spektra kliničke prezentacije psorijaze, ali i rani znak ispoljavanja psorijaznog artritisa (PsA). Obično je teško prepoznati prisustvo entezitisa kod bolesnika sa psorijazom, a posebno je teško razlikovati ga od drugih uzroka ekstraartikularnog bola. Ehosonografija
(ES) je postala sastavni deo ispitivanja reumatoloških bolesnika, a u pogledu dijagnostike entezitisa suverena metoda, sa standardizovanim ES algoritmima kao što su Glasgow Ultrasound Enthesis Scoring System (GUESS) i Madrid Sonographic Enthesitis Index Scoring System (MASEI) skorovi. Ciljevi ove studije bili su da se ustanovi prevalenca ES znakova prisustva entezitisa, da se uporede ti rezultati sa razultatima screening upitnika i da se ispita moguća povezanost entezitisa dokazanog pomoću ES sa kvalitetom života kod bolesnika sa psorijazom, bez dijagnoze PsA. Metode. Sprovedena je studija preseka kod 67 bolesnika sa psorijazom koji nisu bili lečeni sistemskom terapijom. Prisustvo klinički manifestnog entezitisa utvrđivano je pregledom reumatologa, sistemska inflamacija je procenjivana na osnovu serumske kocentracije C-reaktivnog proteina (CRP). Indeksi Psoriasis Area Severity Index (PASI) i Body Surface Area-Psoriasis (BSA-PsO), kao mere zahvaćenosti kože, određivani su od strane dermatologa. Ispitanici su sami popunjavali vizuelnu analognu skalu (VAS) bola i screening upitnike za prisustvo PsA – Toronto Psoriatic Arthritis Screening (ToPAS), Psoriasis Epidemiology Screening Tool (PEST), Psoriatic Arthritis Screening and Evaluation (PASE), Early Psoriatic Arthritis Screening Questionnaire (EARP) i Psoriasis and Arthrosis Screening Questionnaire (PASQ). Skorovi GUESS i MASEI određivani su pomoću ES. Kvalitet života je procenjivan na osnovu Dermatology Life Quality Index (DLQI) upitnika. Rezultati. Kliničkim pregledom, entezitis je ustanovljen kod 8,7% ispitanika. Na osnovu ES ispitivanja preko GUESS i MASEI skorova, samo 7%, odnosno 2% ispitanika nije imalo znake entezitisa. Trajanje psorijaze i životno doba ispitanika bili su u značajnoj korelaciji sa vrednostima GUESS i MASEI skorova, dok sistemska inflamacija, vrednosti VAS, PASI i BSA-PsO skorova nisu pokazali značajnu povezanost. Skorovi GUESS i MASEI bili su u značajnoj korelaciji sa skorovima svih screening upitnika, kao i sa DLQI skorom. Zaključak. Primenom ES može se dokazati entezitis češće nego kliničkim pregledom ili pomoću screening upitnika, mada je postojala korelacija između MASEI i/ili GUESS skorova sa rezultatima screening upitnika. ES je značajna dijagnostička metoda u multidisciplinarnom pristupu dijagnostici i lečenju psorijaze.
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