Características clínicas e socioeconômicas de pacientes com psoríase e artrite psoriásica em uma população de baixa renda

Abstract

Psoriasis (PsO) is a chronic inflammatory disease affecting the integumentary system and may also involve the joints, characterizing psoriatic arthritis (PsA). Inflammatory mediators associated with obesity and metabolic syndrome, such as cytokines and adipokines, have been implicated in the pathogenesis of PsO and PsA. Environmental and socioeconomic factors also influence both conditions; however, there are few studies involving low-income, non-predominantly White populations outside the Northern Hemisphere. We described the clinical profile of PsO and PsA in a low-income population, evaluating the impact of socioeconomic and environmental factors, including low latitude. Patients with PsO and PsA (CASPAR criteria), seen between January 2023 and January 2025, were examined, and medical records were reviewed to exclude other causes of arthritis and comorbidities. We recorded body mass index (BMI), serum C-reactive protein (CRP), Psoriasis Area and Severity Index (PASI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Disease Activity in Psoriatic Arthritis (DAPSA), Health Assessment Questionnaire (HAQ-DI), use of disease-modifying antirheumatic drugs (DMARDs), and Short Form-36 (SF-36) scores, as well as monthly family income and educational level. A total of 303 patients were included (149 with PsO and 154 with PsA), with a median age of 53 years (IQR: 38–61), of whom 188 (62.05%) were female. Plaque psoriasis (133; 89.26%) and polyarticular involvement (91; 59.09%) predominated. Most participants (192; 63.37%) reported a monthly income ≤ 1 minimum wage. The median BMI was 28.20 kg/m2 (IQR: 24.91–32.42), similar between PsO and PsA groups. Median CRP levels were 0.30 mg/dL (IQR: 0.20–0.70) in PsO and 0.84 mg/dL (IQR: 0.3–2.0) in PsA. The median PASI was 2.20 (IQR: 0.58–4.25) in PsO and 1.00 (IQR: 0–2.80) in PsA. Overall, disease activity was low, with ASDAS-CRP 2.20 (IQR: 1.00–2.90), BASDAI 3.50 (IQR: 0.75–5.30), and DAPSA 12.75 (IQR: 2.92–23.88). Quality of life, assessed by SF-36, was worse in PsA compared to PsO. Women with PsO had worse HAQ-DI scores than men (p = 0.005). Patients with lower income showed worse performance in the domains of physical functioning (p = 0.020), role physical (p = 0.028), and social functioning (p = 0.045).

Most patients were receiving biologic therapies, with 111 (72.08%) in the PsA group and 93 (62.42%) in the PsO group. Despite low income and educational levels, with 116 (38.28%) having fewer than 8 years of schooling and only 70 (23.1%) having higher education, we observed low disease activity in both PsO and PsA. Women, despite more frequent use of DMARDs, had worse quality of life scores and greater symptom burden. This is the first description of a low-income, low-education population living at low latitude with PsO and PsA. These findings are noteworthy, as they suggest a better prognosis than that observed in populations with higher income and education levels living at higher latitudes.