Exploring the Association Between Blood Indices and Skin and Joint Activity of Psoriatic Arthritis
Abstract
The exact cause of psoriatic arthritis is still unknown, but hypotheses suggest the role of hematological parameters in the onset and severity of the disease. This study evaluated the hematological indices and their association with skin and joint activity in psoriatic arthritis.
This cross-sectional study included 74 patients with psoriatic arthritis. Demographical and clinical data, blood indices, psoriasis area and severity index (PASI) score and disease activity in psoriatic arthritis (DAPSA) scores were calculated for all patients.
The mean age of the patients was 48.89±12.03 years and most were female (n=49). A significant correlation was observed between age and number of underlying diseases with PASI and DAPSA scores. Mean PASI and DAPSA scores were 5.19 and 15.13, respectively. The severity of psoriasis was mild in 58.1%, moderate in 36.5%, and severe in 4.5% of the cases. The activity of psoriatic arthritis was improved in 2.1%, low in 55.4%, moderate in 24.3%, and high in 1.8% of the patients. A significant association was found between erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet (PLT) count, mean platelet volume (MPV), and PASI scores, while no statistically significant association was reported for PLR. A significant correlation was observed between ESR, CRP, RDW, NLR, PLR, PLT, and DAPSA scores, while no statistically significant association was found for MPV.
The findings indicated that inflammatory and hematological markers can be helpful factors in evaluating the severity of psoriasis and psoriatic arthritis.
1. Harrison SR, Aung Din BNR, Marzo‑Ortega H, Helliwell PS. Recent advances in the management of psoriatic arthritis: practical considerations. Polish Arch Intern Med. 2024;134(1).
2. Zhao SS, Marzo-Ortega H. Advances in psoriatic arthritis six decades on. Clin Ther. 2023;45(9):808-9.
3. Kishimoto M, Deshpande GA, Fukuoka K, Kawakami T, Ikegaya N, Kawashima S, et al. Clinical features of psoriatic arthritis. Best Pract Res Clin Rheumatol. 2021;35(2):101670.
4. Alinaghi F, Calov M, Kristensen LE, Gladman DD, Coates LC, Jullien D, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-65.e19.
5. Carvalho AL, Hedrich CM. The Molecular Pathophysiology of Psoriatic Arthritis—The Complex Interplay Between Genetic Predisposition, Epigenetics Factors, and the Microbiome [Internet]. Vol. 8, Frontiers in Molecular Biosciences. 2021.
6. Azuaga AB, Ramírez J, Cañete JD. Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci. 2023;24(5).
7. Rida MA, Chandran V. Challenges in the clinical diagnosis of psoriatic arthritis. Clin Immunol. 2020;214:108390.
8. Amer AS, Al Shambaky AY, Ameen SG, Sobih AK. Hematological indices in psoriatic enthesopathy: relation to clinical and ultrasound evaluation. Clin Rheumatol. 2024 Jun;43(6):1909-1917. doi: 10.1007/s10067-024-06951-2. Epub 2024 Apr 8. PMID: 38584198; PMCID: PMC11111547. .
9. Korendowych E, Owen P, Ravindran J, Carmichael C, McHugh N. The clinical and genetic associations of anti-cyclic citrullinated peptide antibodies in psoriatic arthritis. Rheumatology (Oxford). 2005;44(8):1056–60.
10. Punzi L, Podswiadek M, Oliviero F, Lonigro A, Modesti V, Ramonda R, et al. Laboratory findings in psoriatic arthritis. Reumatismo. 2007;(59 Suppl 1 ):52–5.
11. Hackett S, Ogdie A, Coates LC. Psoriatic arthritis: prospects for the future. Ther Adv Musculoskelet Dis. 2022;14:1759720X221086710.
12. Conic RR, Damiani G, Schrom KP, Ramser AE, Zheng C, Xu R, et al. Psoriasis and Psoriatic Arthritis Cardiovascular Disease Endotypes Identified by Red Blood Cell Distribution Width and Mean Platelet Volume. J Clin Med. 2020;9(1).
13. Nguyen HT, Vo LDH, Pham NN. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory markers in psoriasis: a case-control study. Dermatology reports. 2023;15(1):9516.
14. Soliman WM, Sherif NM, Ghanima IM, EL-Badawy MA. Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: Relation with disease activity and lupus nephritis. Reumatol Clínica. 2020;16(4):255–61.
15. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665–73.
16. Kerschbaumer A, Smolen JS, Aletaha D. Disease activity assessment in patients with psoriatic arthritis. Best Pract & Res Clin Rheumatol. 2018;32(3):401–14.
17. Smolen JS, Schoels M, Aletaha D, Schoels M, Aletaha D. DAPSA revisão. 2015;
18. Gisondi P, Geat D, Lippi G, Montagnana M, Girolomoni G. Increased red blood cell distribution width in patients with plaque psoriasis. J Med Biochem. 2021;40(2):199–201.
19. Ozisler C, Sandikci SC. Evaluation of red blood cell distribution width in patients with psoriatic arthritis. Egypt Rheumatol. 2020;42(4):309–12.
20. Kılıç S, Reşorlu H, Işık S, Oymak S, Akbal A, Hiz MM, et al. Association between mean platelet volume and disease severity in patients with psoriasis and psoriatic arthritis. Adv Dermatology Allergol Dermatologii i Alergol [Internet]. 2017;34(2):126–30.
21. Leung YY, Eder L, Orbai A-M, Coates LC, de Wit M, Smolen JS, et al. Association between obesity and likelihood of remission or low disease activity status in psoriatic arthritis applying index-based and patient-based definitions of remission: a cross-sectional study. RMD open. 2023;9(3).
22. Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d’Elia H, et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther. 2019;21(1):17.
23. Ivanov S, Merlin J, Lee MKS, Murphy AJ, Guinamard RR. Biology and function of adipose tissue macrophages, dendritic cells and B cells. Atherosclerosis. 2018;271:102–10.
24. Chehimi M, Vidal H, Eljaafari A. Pathogenic Role of IL-17-Producing Immune Cells in Obesity, and Related Inflammatory Diseases. J Clin Med. 2017;6(7).
25. Wolk K, Sabat R. Adipokines in psoriasis: An important link between skin inflammation and metabolic alterations. Rev Endocr Metab Disord. 2016;17(3):305–17.
26. Hägg D, Sundström A, Eriksson M, Schmitt-Egenolf M. Severity of Psoriasis Differs Between Men and Women: A Study of the Clinical Outcome Measure Psoriasis Area and Severity Index (PASI) in 5438 Swedish Register Patients. Am J Clin Dermatol. 2017;18(4):583–90.
27. Duruöz MT, Gezer HH, Nas K, Kılıç E, Sargın B, Kasman SA, et al. Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study. Jt Bone Spine. 2021;88(4):105177.
28. Kasiem FR, Kok MR, Luime JJ, Tchetverikov I, Wervers K, Korswagen L-A, et al. The burden of psoriasis in patients with early psoriatic arthritis. Rheumatology [Internet]. 2022;61(4):1570–8.
29. Mustafa TA, Esho MI. Association Between Mean Platelet Volume And Disease Activity In Patients With Psoriatic Arthritis. Iraqi J Pharm. 2022;19(2):46–54.
30. Izci Duran T, Pamukcu M. Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis. Croat Med J. 2022;63(2):141–7.
31. Haroon M, Gallaghar P, Ahmad M, FitzGerald O. Elevated CRP even at the first visit to a rheumatologist is associated with long-term poor outcomes in patients with psoriatic arthritis. Clin Rheumatol. 2020;39(10):2951–61.
32. Magee C, Jethwa H, FitzGerald OM, Jadon DR. Biomarkers predictive of treatment response in psoriasis and psoriatic arthritis: a systematic review. Ther Adv Musculoskelet Dis. 2021;13:1–14.
33. Gialouri CG, Evangelatos G, Pappa M, Karamanakos A, Iliopoulos A, Tektonidou MG, et al. Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022;14:1759720X221122417.
34. Nageen S, Shah R, Sharif S, Jamgochian M, Waqas N, Rao B. Platelet Count, Mean Platelet Volume, and Red Cell Distribution Width as Markers for Psoriasis Severity. J Drugs Dermatol. 2022 Feb;21(2):156–61.
35. Olumuyiwa-Akeredolu O-O, Page MJ, Soma P, Pretorius E. Platelets: emerging facilitators of cellular crosstalk in rheumatoid arthritis. Nat Rev Rheumatol. 2019;15(4):237–48.
36. Talukdar M, Barui G, Adhikari A, Karmakar R, Ghosh UC, Das TK. A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis. J Clin Diagn Res. 2017;11(1):EC01–4.
37. Tekeoğlu İ, Gürol G, Harman H, Karakeçe E, Çiftçi İH. Overlooked hematological markers of disease activity in rheumatoid arthritis. Int J Rheum Dis. 2016;19(11):1078–82.
38. Liu Z, Perry LA, Morgan V. The association between platelet indices and presence and severity of psoriasis: a systematic review and meta-analysis. Clin Exp Med. 2023;23(2):333–46.
39. Tamagawa-Mineoka R, Katoh N, Ueda E, Masuda K, Kishimoto S. Elevated platelet activation in patients with atopic dermatitis and psoriasis: increased plasma levels of beta-thromboglobulin and platelet factor 4. Allergol Int Off J Japanese Soc Allergol. 2008;57(4):391–6.
40. Kim DS, Shin D, Lee MS, Kim HJ, Kim DY, Kim SM, et al. Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol [Internet]. 2016;43(3):305–10.
41. Albayrak H. Neutrophil-to-Lymphocyte Ratio, Neutrophil-to-Monocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immune-Inflammation Index in Psoriasis Patients: Response to Treatment with Biological Drugs. J Clin Med. 2023;12(17).
42. Bahar A, Dincer K, Sezer S. Systemic Immune Inflammation Index as a Reliable Disease Activity Marker in Psoriatic Arthritis. 2022;32(06):773–8.
43. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017 Mar;376(10):957–70.
44. Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021;35(9):e23964.
2. Zhao SS, Marzo-Ortega H. Advances in psoriatic arthritis six decades on. Clin Ther. 2023;45(9):808-9.
3. Kishimoto M, Deshpande GA, Fukuoka K, Kawakami T, Ikegaya N, Kawashima S, et al. Clinical features of psoriatic arthritis. Best Pract Res Clin Rheumatol. 2021;35(2):101670.
4. Alinaghi F, Calov M, Kristensen LE, Gladman DD, Coates LC, Jullien D, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-65.e19.
5. Carvalho AL, Hedrich CM. The Molecular Pathophysiology of Psoriatic Arthritis—The Complex Interplay Between Genetic Predisposition, Epigenetics Factors, and the Microbiome [Internet]. Vol. 8, Frontiers in Molecular Biosciences. 2021.
6. Azuaga AB, Ramírez J, Cañete JD. Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci. 2023;24(5).
7. Rida MA, Chandran V. Challenges in the clinical diagnosis of psoriatic arthritis. Clin Immunol. 2020;214:108390.
8. Amer AS, Al Shambaky AY, Ameen SG, Sobih AK. Hematological indices in psoriatic enthesopathy: relation to clinical and ultrasound evaluation. Clin Rheumatol. 2024 Jun;43(6):1909-1917. doi: 10.1007/s10067-024-06951-2. Epub 2024 Apr 8. PMID: 38584198; PMCID: PMC11111547. .
9. Korendowych E, Owen P, Ravindran J, Carmichael C, McHugh N. The clinical and genetic associations of anti-cyclic citrullinated peptide antibodies in psoriatic arthritis. Rheumatology (Oxford). 2005;44(8):1056–60.
10. Punzi L, Podswiadek M, Oliviero F, Lonigro A, Modesti V, Ramonda R, et al. Laboratory findings in psoriatic arthritis. Reumatismo. 2007;(59 Suppl 1 ):52–5.
11. Hackett S, Ogdie A, Coates LC. Psoriatic arthritis: prospects for the future. Ther Adv Musculoskelet Dis. 2022;14:1759720X221086710.
12. Conic RR, Damiani G, Schrom KP, Ramser AE, Zheng C, Xu R, et al. Psoriasis and Psoriatic Arthritis Cardiovascular Disease Endotypes Identified by Red Blood Cell Distribution Width and Mean Platelet Volume. J Clin Med. 2020;9(1).
13. Nguyen HT, Vo LDH, Pham NN. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory markers in psoriasis: a case-control study. Dermatology reports. 2023;15(1):9516.
14. Soliman WM, Sherif NM, Ghanima IM, EL-Badawy MA. Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: Relation with disease activity and lupus nephritis. Reumatol Clínica. 2020;16(4):255–61.
15. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665–73.
16. Kerschbaumer A, Smolen JS, Aletaha D. Disease activity assessment in patients with psoriatic arthritis. Best Pract & Res Clin Rheumatol. 2018;32(3):401–14.
17. Smolen JS, Schoels M, Aletaha D, Schoels M, Aletaha D. DAPSA revisão. 2015;
18. Gisondi P, Geat D, Lippi G, Montagnana M, Girolomoni G. Increased red blood cell distribution width in patients with plaque psoriasis. J Med Biochem. 2021;40(2):199–201.
19. Ozisler C, Sandikci SC. Evaluation of red blood cell distribution width in patients with psoriatic arthritis. Egypt Rheumatol. 2020;42(4):309–12.
20. Kılıç S, Reşorlu H, Işık S, Oymak S, Akbal A, Hiz MM, et al. Association between mean platelet volume and disease severity in patients with psoriasis and psoriatic arthritis. Adv Dermatology Allergol Dermatologii i Alergol [Internet]. 2017;34(2):126–30.
21. Leung YY, Eder L, Orbai A-M, Coates LC, de Wit M, Smolen JS, et al. Association between obesity and likelihood of remission or low disease activity status in psoriatic arthritis applying index-based and patient-based definitions of remission: a cross-sectional study. RMD open. 2023;9(3).
22. Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d’Elia H, et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther. 2019;21(1):17.
23. Ivanov S, Merlin J, Lee MKS, Murphy AJ, Guinamard RR. Biology and function of adipose tissue macrophages, dendritic cells and B cells. Atherosclerosis. 2018;271:102–10.
24. Chehimi M, Vidal H, Eljaafari A. Pathogenic Role of IL-17-Producing Immune Cells in Obesity, and Related Inflammatory Diseases. J Clin Med. 2017;6(7).
25. Wolk K, Sabat R. Adipokines in psoriasis: An important link between skin inflammation and metabolic alterations. Rev Endocr Metab Disord. 2016;17(3):305–17.
26. Hägg D, Sundström A, Eriksson M, Schmitt-Egenolf M. Severity of Psoriasis Differs Between Men and Women: A Study of the Clinical Outcome Measure Psoriasis Area and Severity Index (PASI) in 5438 Swedish Register Patients. Am J Clin Dermatol. 2017;18(4):583–90.
27. Duruöz MT, Gezer HH, Nas K, Kılıç E, Sargın B, Kasman SA, et al. Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study. Jt Bone Spine. 2021;88(4):105177.
28. Kasiem FR, Kok MR, Luime JJ, Tchetverikov I, Wervers K, Korswagen L-A, et al. The burden of psoriasis in patients with early psoriatic arthritis. Rheumatology [Internet]. 2022;61(4):1570–8.
29. Mustafa TA, Esho MI. Association Between Mean Platelet Volume And Disease Activity In Patients With Psoriatic Arthritis. Iraqi J Pharm. 2022;19(2):46–54.
30. Izci Duran T, Pamukcu M. Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis. Croat Med J. 2022;63(2):141–7.
31. Haroon M, Gallaghar P, Ahmad M, FitzGerald O. Elevated CRP even at the first visit to a rheumatologist is associated with long-term poor outcomes in patients with psoriatic arthritis. Clin Rheumatol. 2020;39(10):2951–61.
32. Magee C, Jethwa H, FitzGerald OM, Jadon DR. Biomarkers predictive of treatment response in psoriasis and psoriatic arthritis: a systematic review. Ther Adv Musculoskelet Dis. 2021;13:1–14.
33. Gialouri CG, Evangelatos G, Pappa M, Karamanakos A, Iliopoulos A, Tektonidou MG, et al. Normal C-reactive protein in active psoriatic arthritis: results from real-world clinical practice. Ther Adv Musculoskelet Dis. 2022;14:1759720X221122417.
34. Nageen S, Shah R, Sharif S, Jamgochian M, Waqas N, Rao B. Platelet Count, Mean Platelet Volume, and Red Cell Distribution Width as Markers for Psoriasis Severity. J Drugs Dermatol. 2022 Feb;21(2):156–61.
35. Olumuyiwa-Akeredolu O-O, Page MJ, Soma P, Pretorius E. Platelets: emerging facilitators of cellular crosstalk in rheumatoid arthritis. Nat Rev Rheumatol. 2019;15(4):237–48.
36. Talukdar M, Barui G, Adhikari A, Karmakar R, Ghosh UC, Das TK. A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis. J Clin Diagn Res. 2017;11(1):EC01–4.
37. Tekeoğlu İ, Gürol G, Harman H, Karakeçe E, Çiftçi İH. Overlooked hematological markers of disease activity in rheumatoid arthritis. Int J Rheum Dis. 2016;19(11):1078–82.
38. Liu Z, Perry LA, Morgan V. The association between platelet indices and presence and severity of psoriasis: a systematic review and meta-analysis. Clin Exp Med. 2023;23(2):333–46.
39. Tamagawa-Mineoka R, Katoh N, Ueda E, Masuda K, Kishimoto S. Elevated platelet activation in patients with atopic dermatitis and psoriasis: increased plasma levels of beta-thromboglobulin and platelet factor 4. Allergol Int Off J Japanese Soc Allergol. 2008;57(4):391–6.
40. Kim DS, Shin D, Lee MS, Kim HJ, Kim DY, Kim SM, et al. Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol [Internet]. 2016;43(3):305–10.
41. Albayrak H. Neutrophil-to-Lymphocyte Ratio, Neutrophil-to-Monocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immune-Inflammation Index in Psoriasis Patients: Response to Treatment with Biological Drugs. J Clin Med. 2023;12(17).
42. Bahar A, Dincer K, Sezer S. Systemic Immune Inflammation Index as a Reliable Disease Activity Marker in Psoriatic Arthritis. 2022;32(06):773–8.
43. Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med. 2017 Mar;376(10):957–70.
44. Wu J, Yan L, Chai K. Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis. J Clin Lab Anal. 2021;35(9):e23964.
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How to Cite
1.
Rostamian A, Aghayani S, Najafizadeh SR, Saffarian Z, Yaseri M. Exploring the Association Between Blood Indices and Skin and Joint Activity of Psoriatic Arthritis. Iran J Allergy Asthma Immunol. 2024;:1-13.
