The Relationship Between C-Reactive Protein Level, Disease Severity and Psoriatic Arthritis In Psoriasis Patients

Öz

Objective: This study aimed to determine the relationship between C-reactive protein psoriasis and psoriatic arthritis, which are in the group of Immune-Mediated Inflammatory Disease.
Materials and Methods: 201 psoriasis patients with or without psoriatic arthritis aged between 18-70 years and 98 healthy individuals aged between 18-70 years were included in the study. Psoriasis severity was calculated by psoriasis severity index, concurrent serum C - reactive protein level (by immunoturbidimetric latex method) was evaluated, and patients were evaluated for psoriatic arthritis in physical therapy and rehabilitation clinic. C - reactive protein levels between groups were compared. Correlation between C - reactive protein level and psoriasis severity index was evaluated in psoriasis patients.
Results: C - reactive protein levels were higher in psoriasis patients than the normal population (p <0.001), but there was no correlation between C - reactive protein level and psoriasis severity. C - reactive protein levels were higher in patients with active psoriatic arthritis compared to the control group (p <0.001) and psoriasis patients (p <0.001). In terms of C - reactive protein level values, no statistically significant difference was found between active psoriatic arthritis patients and inactive psoriatic arthritis patients (p = 0.449).
Conclusion: Although C - reactive protein level is higher in psoriasis patients compared to normal population, it is not correlated with disease severity, and therefore it is not useful to use psoriasis in the follow-up; however, we think that C - reactive protein level may be used in follow-up for psoriatic arthritis development in psoriasis patients. The fact that C - reactive protein level was not significantly different in active and inactive psoriatic arthritis patients, C - reactive protein level is not a sufficient indicator to assess whether psoriatic arthritis is active or inactive.

Anahtar Kelimeler

• Psoriasis,Psoriasis severity index,Psoriatic arthritis,C - reactive protein level

Psoriasis Hastalarında C-Reaktif Protein Düzeyinin Hastalık Şiddeti ve Psoriatik Artrit İle İlişkisi

Öz

Amaç: Bu çalışmada “Immune Mediated Inflammatory Disease (İmmün Aracılı İltihabi Hastalık)” grubuna dâhil olan psoriasis ve psoriatik artritte, C-reaktif proteinin psoriasis şiddeti ve psoriatik artrit ile ilişkisini tespit etmek amaçlandı.
Gereç ve Yöntem: Çalışmaya 18-70 yaş arası psoriatik artriti olan veya olmayan toplam 201 psoriasis hastası ve kontrol grubu olarak 18-70 yaş arası 98 sağlıklı birey alındı. Psoriasis şiddeti psoriasis alan şiddet indeksi ile hesaplandı ve eşzamanlı serum C-Reaktif Protein düzeyi (immunoturbidimetric latex yöntemi ile) bakılıp hastalar fizik tedavi ve rehabilitasyon kliniğinde psoriatik artrit yönünden değerlendirildi. Gruplar arası C-Reaktif Protein düzeyleri karşılaştırıldı. Psoriasis hastalarında C-Reaktif Protein düzeyi ve psoriasis alan şiddet indeksi korelasyonuna bakıldı.
Bulgular: C-Reaktif Protein düzeyinin, psoriasis hastalarında normal popülasyona göre yüksek olduğu (p<0,001) ancak psoriasis şiddeti arasında korelasyon olmadığı saptandı (p=0,093) . C-Reaktif Protein değerleri, aktif psoriatik artrit hastalarında kontrol grubuna (p<0,001) ve psoriasis hastalarına (p<0,001) göre yüksek bulundu. C-Reaktif Protein değerleri açısından aktif psoriatik artrit hastaları ile inaktif psoriatik artrit hastaları arasında istatistiksel olarak anlamlı fark bulunmadı (p=0,449).
Sonuç: C-Reaktif Protein’in psoriasis hastalarında normal insanlara göre yüksek olmasına rağmen, hastalık şiddetiyle korele olmadığından, psoriasis şiddeti takibinde kullanımının yararlı olmayacağı; ancak psoriasis hastalarında psoriatik artrit gelişimi açısından takipte kullanılanılabileceğini düşünmekteyiz. Aktif ve inaktif psoriatik artrit hastalarında C-Reaktif Protein düzeyi açısından anlamlı fark saptanmaması, psoriatik artritin aktif veya inaktif dönemde olduğunu değerlendirmede tek başına yeterli bir belirteç olmadığı sonucunu doğurmaktadır. 

Anahtar Kelimeler

• Psoriasis,Psoriasis alan şiddet indeksi,Psoriatik artrit,C Reaktif Protein Seviyesi

Kaynakça

1. 1. Gülekon A, Adışen E. Psoriasis ve Komorbiditeler. Türkderm-Deri Hastalıkları ve Frengi Arşivi Dergisi 2008; 42 Özel Sayı 2: 23-25
2. 2. Rocha-Pereira, P., Santos-Silva, A., Rebelo, I., Figueiredo, A., Quintanilha, A. and Teixeira, F. (2004), The inflammatory response in mild and in severe psoriasis. British Journal of Dermatology, 150: 917–928. doi: 10.1111/j.1365-2133.2004.05984.x
3. 3. Strober B, Teller C, Yamauchi P, Miller JL, Hooper M, Yang YC, Dann F. Effects of etanercept on C-reactive protein levels in psoriasis and psoriatic arthritis. Br J Dermatol 2008; 159: 322-30.
4. 4. Türkoğlu Eİ, Gürgün C, Zoghi M, Türkoğlu C. Kararlı anjina pektorisi olan ve efor testi pozitif bulunan ayaktan hastalarda serum C-reaktif protein düzeyleri ile koroner arter hastalığı ile ilişkisi. Anadolu Kardiyol Derg 2004; 4: 199-202.
5. 5. Christophers E, Mrowietz U: Psoriasis: Fitzpatrick’s Dermatology in General Medicine. Beşinci baskı. Freedberg IM, Eisen AZ, Wolf K, Austen KF, Goldsmith AL, Katz IS, Fitzpatrick TB (eds), McGraw- Hill Inc, New York 1999:495-521.
6. 6. K. Moen1, 2, J.G. Brun3, M. Valen3, L. Skartveit4, E.K. Ribs Eribe5, I. Olsen5,R. Jonsson1,3,6. Synovial inflammation in active rheumatoid arthritis and psoriatic arthritis facilitates trapping of a variety of oral bacterial DNAs. Clinical and Experimental Rheumatology 2006; 24: 656-663.
7. 7. Punzi L, Pianon M, Rossini P, et al. Clinical and labaratory manifestations of elderly onset psoriatic arthritis: a comparison with younger onset disease. Ann Rheum Dis 1999; 58:226-29.
8. 8. Salvarani C, Macchioni P, Cremonesi T, et al. The cervical spine in patients with psoriatic arthritis: a clinical, radiological and immunogenetic study. Ann Rheum Dis 1992;51:73-7.

9. 9. IshakR, Hassan K: The erythrocyte sedimentation rate, C-reactive protein, plasma fibrinogen and viscosity in chronic renal disease patients with infection, Malays J Pathol 1989;11:29-31.
10. 10. Katz PR, Gutman SI, Richman G, Karuza J, Bartholomew WR, Baum J: Erythrocyte sedimentation rate and C-reactive protein compared in the elderly, Br J Clin Pract 1989;43(7):252-4.
11. 11. Kirkeby OJ, Risoe C, Vikland R: Significance of a high erythrocyte sedimentation rate in general practice, Clin Chem 1989 ;35(3):466-8.
12. 12. Yenen O: Enfeksiyon hastalıklarında akut faz reaktanları, “Çalangu S, Eraksoy H, Özsüt H (eds): Enfeksiyon Hastalıkları ’90-’91” kitabında s.21-42,Yüce Yayınları, İstanbul (1990)
13. 13. Pincus MR, Abraham NZ: Interpreting laboratory results, “Henry JB: Clinical, LaboraticalDiagnosis andManagement by LaboratoryMethods” kitabında s.92-107, Saunders Co., Philadelphia (2001).
14. 14. Coimbra, S., Oliveira, H., Reis, F., Belo, L., Rocha, S., Quintanilha, A., Figueiredo, A., Teixeira, F., Castro, E., Rocha-Pereira, P. and Santos-Silva, A. (2010), C-reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy. Journal of the European Academy of Dermatology and Venereology, 24: 789–796.
15. 15. Chodorowska, G., Wojnowska, D. and Juszkiewicz-Borowiec, M. (2004), C-reactive protein and α2-macroglobulin plasma activity in medium–severe and severe psoriasis. Journal of the European Academy of Dermatology and Venereology, 18: 180–183.
16. 16. Ohtsuka T. The relation between high-sensitivity c-reactive protein and maximum body mass index in patients with psoriasis. Br J Dermatol 2008; 158: 1141-3.
17. 17. Gisondi P, Malerba M, Malara G, Puglisi Guerra A, Sala R, Radaeli A,Calzavara-Pinton P, Girolomoni G. C-reactive protein and markers for thrombophilia in patients with chronic plaque psoriasis. Int J Immunopathol Pharmacol. 2010 Oct-Dec;23(4):1195-202. PubMed PMID: 21244768.
18. 18. Karabudak O, Ulusoy RE, Erikci AA, Solmazgul E, Dogan B, Harmanyeri Y.Inflammation and hypercoagulable state in adult psoriatic men. Acta Derm Venereol. 2008;88(4):337-40. PubMed PMID: 18709301.
19. 19. Ibrahimbaş Y, Polat M, Serin E, Parlak AH (2010) Cellular Immune Response in Patients with Chronic Plaque Type Psoriasis: Evaluation of Serum Neopterin, Procalcitonin, Anti-Streptolysin O and C Reactive Protein Levels. J Clin Exp Dermatol Res 1:107.
20. 20. Pietrzak AT, Zalewska A, Chodorowska G, Krasowska D, Michalak-Stoma A,Nockowski P, Osemlak P, Paszkowski T, Roliński JM. Cytokines and anticytokines in psoriasis. Clin Chim Acta. 2008 Aug;394(1-2):7-21
21. 21. Selma Emre, Fadime Kılınç, Deniz Demirseren, Melih Akyol. Psoriasis hastalarında C-reaktif protein, yüksek sensitif C-reaktif protein ve hastalık şiddeti ilişkisi. Cumhuriyet Tıp Derg. 2011; 33 (2)
22. 22. Sergeant A, Makrygeorgou A, Chan WC, Thorrat A, Burden D. C-reactive protein in psoriasis. Br J Dermatol 2008; 158: 417-9.
23. 23. Nurhal Mercan Bozkurt, Mehmet Yıldırım, Ali Murat Ceyhan, Yusuf Kara, Hüseyin Vural. Investigation of Serum Visfatin Levels in Patients with Psoriasis. TURKDERM. 2010; 44(1): 15-18.
24. 24. Laurent MR, Panayı GS, Shepherd P. Circulating immune complexes, serum immunoglobulins and acute phase proteins in psoriasis and psoriatic arthritis. Ann Rheum Dis 1981; 40: 66-9.
25. 25. Balcı DD, Yönden Z Doğramacı ÇA, Duran N. Hafif ve orta şiddetli psoriyazis hastalarında serum yüksek sensitif c-reaktif protein ve homosistein düzeyleri. Türkderm 2009; 43: 53-7.
26. 26. L.-S. Tam, B. Tomlinson, T. T.-W. Chu, M. Li, Y.-Y. Leung, L.-W. Kwok, T. K. Li, T. Yu,Y.-E. Zhu, K.-C. Wong, E. W.-L. Kun and E. K. Li. Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation. Rheumatology 2008;47:718–723.
27. 27. P S Helliwell, A Marchesoni, M Peters, R Platt, V Wright. Cytidine deaminase activity, C reactive protein, histidine, and erythrocyte sedimentation rate as measures of disease activity in psoriatic arthritis. Annals of the Rheumatic Diseases 1991; 50: 362-365.