BACKGROUND C-reactive protein (CRP) is often normal in patients with psoriatic disease. Herein, we aimed to define markers of systemic inflammation in patients with monomorphic and polymorphic psoriatic skin, entheseal, and joint disease. METHODS Three-step approach: (i) selection of serum markers elevated in psoriatic arthritis compared healthy controls from a panel of 10 different markers reflecting the pathophysiology of psoriatic disease; (ii) testing of these selected markers as well as C-reactive protein (CRP) in a larger cohort of 210 individuals- 105 healthy controls and 105 patients with psoriatic disease with either monomorphic skin (S), entheseal (E) or joint (A) involvement or polymorphic disease with various combinations of skin, entheseal and joint disease (SE, SA, EA, SEA); (iii) testing whether tumor necrosis factor (TNF) and interleukin (IL)-17 inhibitor therapy normalizes these markers. RESULTS CRP was not elevated or was rarely elevated in the subgroups (S 0%, E 0%, A 20%, SE 7%, SA 33%, EA 27%, SEA 33%) despite active psoriatic disease. In sharp contrast, beta-defensin 2 and lipocalin-2 levels were elevated in the majority of patients with monomorphic skin (93% and 73%) and entheseal (both 53%), but not joint disease (27% and 20%). Conversely, elevations of calprotectin and IL-8 were found in the majority of patients with monomorphic joint disease (both 73%). IL-22 was elevated in all three monomorphic disease manifestations (S 60%, E 46%; A 60%). Furthermore, the vast majority of patients with polymorphic psoriatic disease (SE, SA, EA, SEA) showed widespread marker elevation. IL-17- and TNF inhibitor treatment significantly lowered all 5 markers of inflammation in PsA patients. CONCLUSIONS Systemic inflammation is detectable in the majority of patients with psoriatic disease, even if CRP is normal. The respective marker pattern depends on the manifestation of psoriatic disease with respect to skin, entheseal, and joint involvement.

中文翻译：

---

一套血清标志物，可在缺乏C反应蛋白的情况下检测牛皮癣皮肤，粘膜炎和关节疾病的全身炎症，及其与临床疾病表现的关系。

背景技术C反应蛋白（CRP）在银屑病患者中通常是正常的。在本文中，我们旨在定义单态性和多态性牛皮癣，皮炎和关节疾病患者的全身性炎症标志物。方法三步走法：（i）从一组反映银屑病疾病病理生理的10种不同标记物中选择健康对照中的银屑病关节炎中升高的血清标记物；（ii）在更大的210名患者队列中测试这些选定的标记物以及C反应蛋白（CRP）-105名健康对照者和105名患有银屑病的单形皮肤（S），肠粘膜（E）或关节（ A）受累或多形性疾病，并伴有多种皮肤病，皮肤病和关节病（SE，SA，EA，SEA）；（iii）测试肿瘤坏死因子（TNF）和白介素（IL）-17抑制剂疗法是否使这些标志物正常化。结果尽管发生了银屑病，但亚组中的CRP并未升高或很少升高（S 0％，E 0％，A 20％，SE 7％，SA 33％，EA 27％，SEA 33％）。与之形成鲜明对比的是，大多数具有单形皮肤（93％和73％）和皮肤麻痹（均为53％）但没有关节病（27％和20％）的患者中β-防御素2和lipocalin-2的水平升高。相反，大多数单形性关节疾病患者均发现钙卫蛋白和IL-8升高（均为73％）。IL-22在所有三种单形性疾病表现中均升高（S 60％，E 46％； A 60％）。此外，绝大多数多态性银屑病患者（SE，SA，EA，SEA）显示出广泛的标志物升高。IL-17和TNF抑制剂治疗可显着降低PsA患者的所有5种炎症标志物。结论即使CRP正常，大多数牛皮癣患者仍可检测到全身性炎症。相应的标记模式取决于银屑病在皮肤，粘膜和关节受累方面的表现。