Sevgi KULAKLI, Nilgün ATAKAN, Gökhan ÇAĞLAYAN, Ayşen AKINCI, Levent ÖZÇAKAR

From a dermatologist point of view, enthesopathy and peripheral neuropathy in psoriasis patients

Background: Investigating psoriasis patients’ enthesopathy and peripheral neuropathy, which dermatologists often neglect.Methods: Seventy-four psoriasis patients’ lower limb entheses were evaluated by ultrasonography using Glasgow Ultrasound Enthesitis Scoring Scale (GUESS). Sensory and motor nerve conduction studies in median and ulnar nerve, motor nerve conduction research of peroneal and tibial nerves and sensory conduction study on right sural nerve was performed in 25 patients.Results: 172 of 730 entheses had ultrasonographic enthesopathy symptoms (23.56%). Enthesopathy was substantially more common in cases involving the nail (p = 0.004). The frequency of enthesopathy did not change significantly between symptomatic and asymptomatic patients (p = 0.408). Seven of 25 patients (28%) had a pathology in nerve conduction studies. With increasing GUESS scores, bilateral ulnar and right tibial nerve distal motor latencies were shown to become longer (p = 0.001, p = 0.01, p =0.019), although left ulnar nerve sensory conduction velocity got slower (p = 0.033).Conclusions: Enthesopathy and peripheral nerve dysfunction were frequently observed in psoriasis patients. Dermatologists should be mindful of neuromusculoskeletal disorders in psoriasis patients.

Keywords:

Psoriasis, Enthesopathy, Neuropathy, Ultrasound.,

PDF

___

1. Kerkhof PCM, Schalkwijk J. Psoriasis. In: Bolognia JL, Jorizzo JL, Rapini RP (editors). Dermatology. 2nd ed. 2008. p. 115–36.
2. Gisondi P, Tinazzi I, El-Dalati G, Gallo M, Biasi D, Barbara LM, et al. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study. Ann Rheum Dis. 2008; 67 (1): 26-30.
3. Kaeley GS. Review of the use of ultrasound for the diagnosis and monitoring of enthesitis in psoriatic arthritis. CurrRheumatol Rep. 2011; 13: 338-45.
4. Girolomoni G, Gisondi P. Psoriasis and systemic inflammation: underdiagnosed enthesopathy. J EurAcadDermatolVenereol. 2009; 23: 3-8.
5. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002; 61: 905-10.
6. Buschbacher RM. Rehabilitation of patients with peripheral neuropathies. In: Braddom RL, Buschbacher RM, Chan L, Kowalske KJ, Laskowski ER, Matthews DJ, Ragnarsson KT (editors). Braddom’s Physical Medicine and Rehabilitation. 1st ed. 1996. p. 972-87.
7. Chroni E, Georgiou S, Polychronopoulos P, Sagriotis A, Mosastirli A, Pasmatzi E, et al. Peripheral large nerve fibre function in patients with chronic plaque psoriasis. Eur J Neurol. 2007; 14: 18-20.
8. Agarwal V, Singh R, Chauhan WS, Tahlan A, Ahuja CK, Goel D, et al. A clinical, electrophysiological and pathological study of neuropathy in rheumatoid arthritis. ClinRheumatol. 2008; 27(7): 841-4.
9. Gündüz OH, Kiralp MZ, Özçakar L, Cakar E, Yildirim P, Akyuz G. Nerve conduction studies in patients with ankylosing spondylitis. J Natl Med Assoc. 2010; 102(3): 243-6.
10. Oh SJ. Nerve conduction techniques. In Oh SJ (editor). Clinical Electromyography: Nerve Conduction Studies. 2nd ed. Baltimore, MD, Williams and Wilkins, 1993. p. 39-55.
11. Naredo E, Moller I, de Miguel E, Batlle-Gualda E, Acebes C, Brito E, et al. High prevalance of ultrasonographic synovitis and enthesopathy in patients with psoriasis without psoriatic arthritis: a prospective casecontrol study. Rheumatology. 2011; 50: 1838-48.
12. Gutierrez M, Filippucci E, De Angelis R, Salaffi F, Filosa G, Ruta S, et al. Subclinical entheseal involvement in patients with psoriasis: An ultrasound study. Semin Arthritis Rheum. 2011; 40(5): 407-12.
13. Vyas K, Jain SK, Mittal A, Kumar R, Saxena S, Malviya S. Sonographic evaluation of subclinical enthesopathy in patients of chronic plaque psoriasis. Indian Dermatol Online J. 2020; 11(4): 580-5.
14. Ash ZR, Tinazzi I, Castillo-Gallego C, Kwok C, Wilson C, Goodfield M, et al. Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails. Ann Rheum Dis. 2012; 71(4): 553-6.
15. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population base study. Arthritis Rheum. 2009; 61(2): 233-9.
16. De Simone C, Guerriero C, Giampietruzzi AR, Costantini M, Di Gregorio F, Amerio P. Achilles tendinitis in psoriasis: Clinical and sonographic findings. J Am AcadDermatol. 2003; 49 (2): 217-22.
17. De Filippis LG, Caliri A, Lo Gullo R, Bartolone S, Miceli G, Cannavo SP, et al. Ultrasonography in the early diagnosis of psoriasis-associated enthesopathy. Int J Tissue React. 2005; 27(4): 159-62.
18. Sindrup SH, Ibsen HHW, Sindrup JH, Sindrup EH. Psoriasis and polyneuropathy. Three case histories. ActaDermVenereol. 1990; 70(5): 443-5.
19. Murata K, Miwa H, Kondo T. Myelin-associated glycoprotein-related neuropathy associated with psoriasis: a case report. J Med Case Rep. 2013; 7:4.
20. Baldereschi M, Inzitari M, Di Carlo A, Farchi G, Scafato E, Inzitari D.Epidemiology of distal symmetrical neuropathies in the Italian elderly. Neurology. 2007; 68(18): 1460-7.
21. Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. J NeurolNeurosurg Psychiatry. 1997; 62(4): 310-8.