الفهرس 
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Abstract
Psoriasis (Ps) is a long-lasting immune-mediated disease characterized by erythematous scaly patches. Approximately 30% of individuals with psoriasis (Ps) will develop psoriatic arthritis (PsA) which is defined as a type of chronic inflammatory arthritis characterized by both peripheral articular manifestations and axial skeletal involvement.
A growing number of studies demonstrate that the latest IL-1 family members IL-36 and IL-38 are differently regulated during the course of the disease. Recent studies suggest their role in psoriasis pathogenesis in addition these cytokines may be involved in the context of psoriatic arthritis.
This study aimed to evaluate the levels of interleukin 36 and interleukin 38 in psoriatic patients and assess their relationship to the severity of the disease and joint affection.
This study was a case-control prospective study conducted on psoriatic patients recruited from Dermatology or Phototherapy outpatient clinics of Main University Hospital, Faculty of Medicine, Alexandria University. The study included 40 patients who were diagnosed clinically as psoriatic patients of any type representing the patients group and 30 normal healthy volunteers as the control group.
In the current study, in the patient group, the females were more predominant than males (65% vs 35%, respectively), while males were more than females in the control group (53% vs 46. 7, respectively). No statistically significant difference was found as regards sex between both groups (p= 0. 125). The age of the patient group (47. 50 ± 15. 64) was comparable with the age of the control group (42. 10 ± 11. 38) (p= 0. 114).
Regarding the duration of the disease, the majority of patients (65%) have had the disease for <10 years while 35% of patients have had the disease for >10 years. The disease duration among the patients’ group ranged from 0. 25 to 40 years with a mean ± SD of 9. 52 ± 10. 78 years.
Only 5 out of 40 patients (12. 5%) had a positive family history of psoriasis (first-degree relatives). Sixteen patients (10%) had a medical history. The most frequent medical history was hypertension in 7 patients (17. 5%) followed by diabetes mellitus in 3 patients (7. 5%).
The PASI score among our psoriatic patients ranged from 0. 40 to 32. 9 with a mean ± SD of 14. 91 ± 9. 01. According to the PASI score, the majority of cases (65%) had moderate to severe psoriasis with (>10) scores. The PEST score among psoriatic patients ranged from 0 to 5 with a median of 2. 0. We found that most of our patients (80%) had a PEST score of <3 and eight patients (20%) had a PEST score ≥3, reflecting a high possibility of PsA. The CASPAR score among psoriatic patients ranged from 3-6 with a median of 4. We found 29 of patients (72. 5 %) had a positive CASPAR score.
Using X-rays, 18 out of 40 patients (45%) had abnormalities on imaging, mostly hand abnormalities in 17 (42. 5%) patients. There were 6 patients (15%) who suffered from additional symptomatic joints rather than hands. Knees and feet were affected in 5 patients (12. 5%), and one patient (2. 5%), respectively.
A positive significant relation was observed between CASPAR score and radiological findings of hands. In addition, the late onset of the disease (at >40 years) was related to radiological findings (p=0. 028), particularly hand abnormalities (p=0. 048).
The radiological findings that were detected in hands were periostitis which was found in 12 patients out of 17 (70. 6%), productive bony changes which were found in 3 patients out of 17 (17%), soft tissue swelling which was found in one patient out of 17 (6%), erosive changes which were found in one patient out of 17 (6%) & narrowing of interphalangeal space which was found in 1 patient out of 17 (6%). While other symptomatic joints (knees), radiological findings were degenerative osteoarthritis in five patients out of 5 (100%) & feet which showed periostitis in one patient.
IL-36 serum level was statistically significantly higher in the Ps patients than in the controls (p <0. 001*). There were statistically significant positive correlations between IL-36 level in tissue and PASI scores (p=0. 016*), besides, between PASI, score with IL-36 level in biopsy (p<0. 001*). Also, a statistically positive correlation between IL-36 serum level concentration and CASPAR score (p =0. 020*) was found.
IL-38 was statistically significantly lower in the psoriatic patients than in controls (p <0. 037*). There was a statistically significant negative correlation between serum level of IL-38 and PASI score, (p=0. 018*), also, there was a highly statistically significant negative correlation between PASI score with IL-38 level in tissue biopsy (p<0. 001*). In addition, there was a statistically positive correlation between IL-38 concentration and CASPAR score (p=0. 020*), but it has no statistically significant diagnostic performance to discriminate PSA from Non PSA. Also, there was a statistically significant relation between IL-38 and sex (p-0. 025*). In biopsy cases, the IL-38 level didn’t reach a significant correlation with CASPAR and PEST scores as well as the radiological findings.
On comparison between PsA and non-PsA patients; both groups didn’t show any significant difference as regards sex, age, duration, family, medical history, psoriasis type & PEST score. However higher PASI score was reported in the PsA patients more than the non-PsA patients. IL-36 significantly higher in PsA patients than non-PsA (p=0. 001) but IL-38 level was comparable in both PsA and non-PsA patients.
It is statistically significant that IL-36 can have a diagnostic performance to discriminate PsA from non-PsA patients at a cutoff point>4. 419 mg/dl with sensitivity 89. 66% & specificity 72%. While IL-38 has no statistically significant diagnostic performance to discriminate PsA from Non-PsA.
It was found that IL-36 & PASI score, each of them independent from other factors can be a predictor of PsA, while if we considered IL-36 together with PASI score we will find that IL-36 is the main predictor of PsA.