Objective Increasing psoriasis severity has been associated with comorbidities including cardiovascular disease. The objective of this study was to examine the association of psoriasis severity with the development of PsA. Methods A prospective population-based cohort study was performed within The Health Improvement Network, a UK medical record database. Patients aged 25–60 years with a code for psoriasis were randomly selected between 2008 and 2011. Questionnaires were sent to their general practitioners to confirm the diagnosis of psoriasis and provide the patient’s approximate body surface area (BSA). Incidence of PsA was calculated by BSA, and Cox proportional hazard ratios were used to examine the risk of developing PsA by BSA category after adjusting for other covariates. Results Among 10 474 questionnaires sent, 9987 (95%) were returned, 9069 (91%) had confirmed psoriasis, and BSA was provided for 8881 patients: 52% had mild psoriasis, 36% moderate psoriasis and 12% severe psoriasis. The mean age was 46, and 49% were female. Mean follow-up time was 4.2 years (S.d. 2.1); the incidence of PsA was 5.4 cases per 1000 person-years. After adjusting for age and sex, BSA >10% [hazard ratio (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3–10% (HR 1.44, 95% CI: 1.02, 2.03), obesity (HR 1.64, 95% CI: 1.19, 2.26) and depression (HR 1.68, 95% CI: 1.21, 2.33) were associated with incident PsA. Conclusions In this large prospective cohort study, BSA assessed by general practitioners was a strong predictor of developing PsA, and obesity and depression were additive risk factors.

中文翻译：

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受银屑病影响的体表面积和银屑病关节炎的风险：一项基于人群的前瞻性队列研究

目的 增加银屑病的严重程度与包括心血管疾病在内的合并症有关。本研究的目的是检查银屑病严重程度与 PsA 发展的关系。方法 在英国医疗记录数据库“健康改善网络”中进行了一项基于人群的前瞻性队列研究。在 2008 年至 2011 年间随机选择年龄为 25-60 岁且具有银屑病代码的患者。将问卷发送给他们的全科医生以确认银屑病的诊断并提供患者的大致体表面积 (BSA)。PsA 的发生率由 BSA 计算，Cox 比例风险比用于在调整其他协变量后按 BSA 类别检查发生 PsA 的风险。结果 10 474份问卷中，回收9987份（95%），9069 (91%) 人确诊银屑病，为 8881 名患者提供 BSA：52% 患有轻度银屑病，36% 患有中度银屑病，12% 患有重度银屑病。平均年龄为 46 岁，49% 为女性。平均随访时间为 4.2 年（标准差 2.1）；PsA的发病率为5.4例/1000人年。调整年龄和性别后，BSA > 10% [风险比 (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3–10% (HR 1.44, 95% CI: 1.02, 2.03), 肥胖 (HR 1.64, 95% CI: 1.19, 2.26) 和抑郁症 (HR 1.68, 95% CI: 1.21, 2.33) 与 PsA 事件相关。结论 在这项大型前瞻性队列研究中，全科医生评估的 BSA 是发生 PsA 的强预测因子，肥胖和抑郁是附加危险因素。36% 中度银屑病和 12% 重度银屑病。平均年龄为 46 岁，49% 为女性。平均随访时间为 4.2 年（标准差 2.1）；PsA的发病率为5.4例/1000人年。调整年龄和性别后，BSA > 10% [风险比 (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3–10% (HR 1.44, 95% CI: 1.02, 2.03), 肥胖 (HR 1.64, 95% CI: 1.19, 2.26) 和抑郁症 (HR 1.68, 95% CI: 1.21, 2.33) 与 PsA 事件相关。结论 在这项大型前瞻性队列研究中，全科医生评估的 BSA 是发生 PsA 的强预测因子，肥胖和抑郁是附加危险因素。36% 中度银屑病和 12% 重度银屑病。平均年龄为 46 岁，49% 为女性。平均随访时间为 4.2 年（标准差 2.1）；PsA的发病率为5.4例/1000人年。调整年龄和性别后，BSA > 10% [风险比 (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3–10% (HR 1.44, 95% CI: 1.02, 2.03), 肥胖 (HR 1.64, 95% CI: 1.19, 2.26) 和抑郁症 (HR 1.68, 95% CI: 1.21, 2.33) 与 PsA 事件相关。结论 在这项大型前瞻性队列研究中，全科医生评估的 BSA 是发生 PsA 的强预测因子，肥胖和抑郁是附加危险因素。10% [风险比 (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3–10% (HR 1.44, 95% CI: 1.02, 2.03), 肥胖 (HR 1.64, 95% CI: 1.19, 2.26)和抑郁症 (HR 1.68, 95% CI: 1.21, 2.33) 与 PsA 事件相关。结论 在这项大型前瞻性队列研究中，全科医生评估的 BSA 是发生 PsA 的强预测因子，肥胖和抑郁是附加危险因素。10% [风险比 (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3–10% (HR 1.44, 95% CI: 1.02, 2.03), 肥胖 (HR 1.64, 95% CI: 1.19, 2.26)和抑郁症 (HR 1.68, 95% CI: 1.21, 2.33) 与 PsA 事件相关。结论 在这项大型前瞻性队列研究中，全科医生评估的 BSA 是发生 PsA 的强预测因子，肥胖和抑郁是附加危险因素。