الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Psoriasis is a chronic inflammatory skin disease, has been related with systemic inflammation and concomitant comorbidities as type 2 diabetes and cardiovascular disease. About 20% of psoriasis have psoriatic arthritis (PsA) which is a progressive disease causing joint damage, early in the disease onset.
The early identification of PsA can contribute to improved outcomes. Despite the fact that numerous studies have identified possible risk factors for PsA in psoriasis patients, it is still unclear which people with psoriasis may eventually develop PsA. These risk factors help us to understand the pathogenesis of PsA and may aid physician in identifying subgroups of psoriasis patients who need to be monitored more closely for PsA symptoms.
Chemokines play vital role in pathogenesis of PsA. In a systemic review on clinical, laboratory, and genetic indicators for psoriatic arthritis Mulder et al found that CXCL10 revealed strong evidence to predict psoriatic arthritis in psoriatic patients.
The aim of this work was to determine and compare the level of CXCL10 in patients with early and longstanding established psoriasis (Pso) and psoriatic arthritis (PsA) and correlate between the level of CXCL10 with different clinical and laboratory parameters in Pso and PsA. Moreover, asses if CXCL10 level could be used for prediction of the onset of PsA in Pso patients.
This study was carried out on 3 groups
• group A: 45 psoriatic patients without current or past arthritis.
group A1: 20 patients newly diagnosed with Pso with disease duration ≤ 1 year before starting treatment.
group A2: 25 patients with longstanding Pso with disease duration of > 5 years on conventional treatment.
• group B: 45 psoriatic arthritis patients fulfilling the classification of psoriatic arthritis (CASPAR) criteria.
group B1: 20 patients with new onset of PsA with disease duration ≤ 1 year before starting treatment.
group B2: 25 patients with established PsA with disease duration of > 5 years on conventional treatment.
• group C: 30 healthy people.
Exclusion criteria: Psoriatic patients on biologic or targeted synthetic DMARDs, patients with other autoimmune skin or rheumatic diseases, gout, and type 1 diabetes mellitus.
All patients were subjected to
Detailed history taking, Clinical assessment including musculoskeletal examination and disease activity score by DAPSA28 (for PsA patients). For Pso patients: assessment of Pso using the Psoriasis Area and Severity Index (PASI), nail assessment by NAPSI, and scalp assessment by SPASI. Laboratory investigations for all patients including routine investigations, inflammatory markers (ESR, CRP), and serological markers including (RF, ANA, anti-CCP).Serum levels of chemokine (C-X-C motif) ligand 10 (CXCL10).
The results of the current study shown that:
Comparison between the diseases subgroups and the control group showed statistically significant difference. CXCL 10 was statistically significant higher in new diagnosed PsA its level was lower in long standing psoriasis and psoriatic arthritis. By follow up newly diagnosed Pso clinically within average time from 12 months to 18 months, six out of twenty cases develop PsA clinically complaining of arthritis and morning stiffness which were baseline high level of CXCL10.
There was statistically significant difference between CXCL 10 level and PASI score in newly diagnosed psoriatic patients; as higher levels of CXCL 10 were detected in patients with severe disease (PASI >12). There was higher level of CXCL 10 in severe than moderate than mild disease
Furthermore, in the current study the ROC curve of CXCL 10 shows that CXCL 10 can significantly distinguish new PsA from psoriatic patients at a cutoff level >150.957 μg/ml with a sensitivity of 95.0 % , a Specificity of 80.0 % , and a Positive predictive value of 57.6% .
Hence, CXCL 10 can be used as a predictor marker for onset PsA in Pso patients in early onset of disease.
Our study concluded that CXCL 10 level is increased in newly diagnosed PsA independently of other clinical variables and may be used as predictive marker for the development of PsA in Pso patients. Also, its level was negatively correlate with time, being high in newly diagnosed PsA and low in long standing cases.