Psoriasis hastalarında yaşa bağlı klinik ve epidemiyolojik özelliklerin karşılaştırmalı değerlendirilmesi
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Tarih
2017
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Ege Üniversitesi Tıp Fakültesi Hastanesi Deri ve Zührevi Hastalıkları Anabilim Dalı polikliniğine 2006-2016 tarihleri arasında başvurmuş ve histopatolojik olarak psoriasis tanısı almış 374 olgu (%54,3 erkek, %45,7 kadın) retrospektif olarak değerlendirildi. Bu çalışmada amaç cinsiyet, yaş, hastalık süresi, aile öyküsü, klinik tip, PAŞİ (Psoriasis Alan Şiddet İndeksi), tırnak ve eklem tutulumu, komorbiditeler ve dermatozlar, verilen tedaviler gibi parametrelerin hem genel, hem de 0-18, 19-40, 41-65 ve 65 yaş üzeri olmak üzere dört yaş grubunda karşılaştırmalı olarak değerlendirmekti. Çalışmanın istatistik analizi IBM SPSS Statistics 21.0 programı kullanılarak yapıldı. Analizler 'Pearson's Chi-Square' testi ile yapıldı. Çalışmamızda hastaların yaşları 6 ile 85 arasında (ortalama 42,17±18,54) idi. Lezyonları başlangıç yaşı 3 ile 70 arasında (ortalama 25,98±14,56) değişiyordu. Hastaların %16'sı 0-18 yaş arasında, %26,7'si 19-40 yaş arasında, %45,5'i 41-65 yaş arasında ve %11,8'i 65 yaş üzerinde idi. Hastaların %67,9'unda plak, %9,1'inde guttat, %6,7'sinde izole saçlı deri, %4,8'inde palmoplantar, %4'ünde palmoplantar püstüler, %3,2'sinde jeneralize püstüler, %2,7'sinde eritrodermik, %1,6'sında invers psoriasis kliniği görüldü. Guttat psoriasis ve jeneralize püstüler psoriasis kadınlarda erkeklere göre anlamlı oranda sık görülmekteydi (p=0,001). Tüm yaş gruplarında en sık görülen klinik tip plak psoriasis olmakla birlikte 0-18 yaş arasında guttat psoriasis (%31,7) sıklığı diğer yaş gruplarına göre anlamlı oranda yüksek bulunmuştur (p<0,001). Ortalama PAŞİ değeri 10,45±7,02 olarak saptandı. En yüksek PAŞİ değerleri 41-65 yaş arasında (11,94±6,88) görülürken, en düşük değerler 0-18 yaş grubunda (6,28±4,63) izlendi. Tırnak tutulumu hastaların %53'7'sinde görüldü. Tırnak tutulumu 41-65 yaş arasındaki hastaların %64,7'sinde görülürken, 0-18 yaş grubunda bu oran %18,3 idi (p<0,001). Jeneralize püstüler psoriasis (n=12) ve eritrodermik psoriasisli (n=10) tüm hastalarda, palmoplantar psoriasisli hastaların %88,9'unda, plak psoriasisli hastaların %57,5'inde tırnak tutulumu izlenirken, invers psoriasisli hastaların hiçbirinde tırnak tutulumu görülmedi. Hastalığın klinik tipi ile tırnak tutulumu sıklığı arasındaki bu ilişki anlamlı bulundu (p<0,001). Eklem tutulumu 24 hastada (%6,4) izlendi. Eklem tutulumu sıklığı 0-18 yaş arasında %1,7, 19-40 yaş arasında %4, 41-65 yaş arasında %8,8, 65 yaş üzerinde %9,1 olarak saptandı (p<0,001). Eklem tutulumu jeneralize püstüler psoriasis hastalarının %50'sinde, eritrodermik psoriasisli hastaların %40'ında izlenirken, palmoplantar psoriasis, palmoplantar püstüler psoriasis, saçlı deri psoriasisi ve invers psoriasis hastalarının hiçbirinde görülmedi (p<0,001). Eklem tutulumu olan hastalarda tırnak tutulumu eklem tutulumu olmayanlara göre anlamlı derecede yüksek sıklıkta (%83,3) izlendi (p<0,001). Komorbiditeler arasında en sık hipertansiyon (%24,3) ve diyabetes mellitus (%22,5) görüldü. Komorbiditelerin sıklığında yaşla birlikte anlamlı artış izlendi (p<0,001). Çalışmaya dahil edilen hastalar arasında sigara kullanım oranı %44,7 olarak saptandı. Sigara kullanımı guttat psoriasis hastalarında düşük oranda (%20,6) iken, palmoplantar püstüler psoriasis hastalarının çoğunda (%93,3) görüldü (p<0,001). Toplam 374 hastanın %24,9'una fototerapi yapılmıştı. Fototerapi palmoplantar psoriasis hastalarının %66,7'sinde, guttat psoriasisli hastaların %44,1'inde, plak psoriasisli hastaların %22,8'inde kullanılmıştı (p<0,001). Hastaların %59,8'ine sistemik tedavi (metotreksat, asitretin ve siklosporin) verilmişti. Sistemik ajanlardan en sık metotreksat (%44,7) kullanılmıştı. Farklı yaş gruplarında verilen sistemik tedavi ajanlarının karşılaştırmalı değerlendirdiğimizde 0-18 yaş arasında en sık kullanılan sistemik tedavi ajanı asitretin (%20) idi. Diğer yaş gruplarında en sık kullanılan sistemik tedavi ajanının metotreksat olduğu görüldü (p<0,001). Hastaların %19,2'sinde biyolojik ajan kullanılmıştı. Biyolojik ajanlardan en sık verilen adalimumab (%9,9) iken, hastaların %8,8'inde etanercept, %8,6'ında infliksimab, %3,5'inde de ustekinumab kullanılmıştı. Biyolojik ajan kullanımı açısından farklı yaş gruplarında istatistiksel olarak anlamlı farklılık saptanmadı (p>0,05). Bu çalışmada, yaşa göre psoriasis hastalarının aile öyküsü, klinik tipleri, PAŞİ değerleri, eklem ve tırnak tutulumları, komorbiditeler, eşlik eden dermatozlar, uygulanan tedaviler gibi parametreler karşılaştırılmıştır. Özellikle klinik tiplerin dağılımında, eklem ve tırnak tutulumunda, komorbiditelerde ve tedavi seçiminde yaşın istatistiksel olarak anlamlı bir faktör olduğu saptanmıştır.
A total number of 374 (54,3% male, 45,7% female) psoriasis patients diagnosed according to the histopathological findings between 2006 – 2016 years, were retrospectively assessed at Ege University Medical Faculty Department of Dermatology and Venereology outpatient clinic. Aim of this study was general and comparative assessment of parameters such as sex, age, duration of disease, family history, clinical types, PASI (Psoriasis Area Severity Index), nail and joint involvement, comorbidities, dermatoses and treatments in four age groups including 0-18, 19-40, 41-65 and above 65. Statistical analyses of study was done using IBM SPSS Statistics 21.0. Analyses were done with ‘Pearson’s Chi-Square’ test. Age of the patients were between 6 and 85 ages (mean 42,17±18,54). Disease onset age ranged between 3 and 70 (mean 25,98±14,56). 16% of the patients were between 0-18 ages, 26,7% were 19-40 ages, 45,5% were 41-65 ages and 11,8% were above 65. 67,9% of patients had plaque, 9,1% had guttate, 6,7% scalp, 4,8% had palmoplantar, 4% had palmoplantar pustular, 3,2% had generalized pustular, 2,7% had erythrodermic and 1,6% had invers psoriasis. Guttate psoriasis and generalized pustular psoriasis observed more frequently in females compared to males (p=0,001). Plaque psoriasis was most observed clinical type in all age groups, while between 0-18 ages guttate psoriasis (31,7%) frequency was statistically significant compared to other age groups (p<0,001). The mean PASI value was 10,45±7,02. Highest PASI values (11,94±6,88) were in 41 – 65 ages, while lowest values (6,28±4,63) were in 0-18 ages. Nail involvement observed in 53,7% of the patients. Nail involvement in 41 – 65 ages were 64,7%, while it was 18,3% in 0-18 age group (p<0,001). Nail involvement were in all patients with generalized pustular (n=12) and erythrodermic psoriasis (n=10) and in 88,9% of palmoplantar psoriasis patients and 57,5% of plaque psoriasis patients. It was not observed in inverse psoriasis patients. Statistically significant relation observed between nail involvement and clinical types (p<0,001). Joint involvement were observed in 24 patients (6,4%). Frequency of joint involvement identified in 1,7% of 0-18 age groups, 4% of 19-40 age groups, 8,8% of 41-65 age groups and 9,1% above 65 ages (p<0,001). Joint involvement were in 50% of patients with generalized pustular and in 40% with erythrodermic psoriasis but not at all in patients with palmoplantar, palmoplantar pustular, scalp and inverse psoriasis (p<0,001). Nail involvement observed in significant frequency (83,3%) in patients with joint involvement compared to patients without (p<0,001). Hypertension (24,3%) and diabetes mellitus (22,5%) were most frequent comorbidities. Frequency of comorbidities significantly increased with age (p<0,001). Tobacco users was 44,7% among patients. It was less frequent (20,6%) in guttate psoriasis, while observed in most of the (93,3%) pustular psoriasis patients (p<0,001). Phototherapy applied to 24,9% of all 374 patients. It was used on 66,7% of palmoplantar, 44,1% of guttate and 22,8% of plaque psoriasis patients (p<0,001). Systemic treatment (methotrexate, cyclosporine, acitretine) was used on 59,8% of patients. Most used systemic agent was methotrexate (44,7%). If to compare systemic agents in different age groups, most used agent in 0-18 age group was acitretine (20%). In other age groups most used systemic agent was methotrexate (p<0,001). Biological treatment was used in 19,2% of patients. Most applied biological agent was adalimumab (9,9%), while etanercet was used in 8,8%, infliximab in 8,6% and ustecinumab in 3,5%. No statistically significant difference observed in use of biological agents in different age groups (p>0,05). In this study, parameters such as family history, clinical types, PASI values, nail and joint involvement, comorbidities, dermatosis and applied treatments compared in different age groups of psoriasis patients. Age defined as a statistically significant factor in distribution of clinical types, nail and joint involvement, comorbidities and selection of treatment modalities.
A total number of 374 (54,3% male, 45,7% female) psoriasis patients diagnosed according to the histopathological findings between 2006 – 2016 years, were retrospectively assessed at Ege University Medical Faculty Department of Dermatology and Venereology outpatient clinic. Aim of this study was general and comparative assessment of parameters such as sex, age, duration of disease, family history, clinical types, PASI (Psoriasis Area Severity Index), nail and joint involvement, comorbidities, dermatoses and treatments in four age groups including 0-18, 19-40, 41-65 and above 65. Statistical analyses of study was done using IBM SPSS Statistics 21.0. Analyses were done with ‘Pearson’s Chi-Square’ test. Age of the patients were between 6 and 85 ages (mean 42,17±18,54). Disease onset age ranged between 3 and 70 (mean 25,98±14,56). 16% of the patients were between 0-18 ages, 26,7% were 19-40 ages, 45,5% were 41-65 ages and 11,8% were above 65. 67,9% of patients had plaque, 9,1% had guttate, 6,7% scalp, 4,8% had palmoplantar, 4% had palmoplantar pustular, 3,2% had generalized pustular, 2,7% had erythrodermic and 1,6% had invers psoriasis. Guttate psoriasis and generalized pustular psoriasis observed more frequently in females compared to males (p=0,001). Plaque psoriasis was most observed clinical type in all age groups, while between 0-18 ages guttate psoriasis (31,7%) frequency was statistically significant compared to other age groups (p<0,001). The mean PASI value was 10,45±7,02. Highest PASI values (11,94±6,88) were in 41 – 65 ages, while lowest values (6,28±4,63) were in 0-18 ages. Nail involvement observed in 53,7% of the patients. Nail involvement in 41 – 65 ages were 64,7%, while it was 18,3% in 0-18 age group (p<0,001). Nail involvement were in all patients with generalized pustular (n=12) and erythrodermic psoriasis (n=10) and in 88,9% of palmoplantar psoriasis patients and 57,5% of plaque psoriasis patients. It was not observed in inverse psoriasis patients. Statistically significant relation observed between nail involvement and clinical types (p<0,001). Joint involvement were observed in 24 patients (6,4%). Frequency of joint involvement identified in 1,7% of 0-18 age groups, 4% of 19-40 age groups, 8,8% of 41-65 age groups and 9,1% above 65 ages (p<0,001). Joint involvement were in 50% of patients with generalized pustular and in 40% with erythrodermic psoriasis but not at all in patients with palmoplantar, palmoplantar pustular, scalp and inverse psoriasis (p<0,001). Nail involvement observed in significant frequency (83,3%) in patients with joint involvement compared to patients without (p<0,001). Hypertension (24,3%) and diabetes mellitus (22,5%) were most frequent comorbidities. Frequency of comorbidities significantly increased with age (p<0,001). Tobacco users was 44,7% among patients. It was less frequent (20,6%) in guttate psoriasis, while observed in most of the (93,3%) pustular psoriasis patients (p<0,001). Phototherapy applied to 24,9% of all 374 patients. It was used on 66,7% of palmoplantar, 44,1% of guttate and 22,8% of plaque psoriasis patients (p<0,001). Systemic treatment (methotrexate, cyclosporine, acitretine) was used on 59,8% of patients. Most used systemic agent was methotrexate (44,7%). If to compare systemic agents in different age groups, most used agent in 0-18 age group was acitretine (20%). In other age groups most used systemic agent was methotrexate (p<0,001). Biological treatment was used in 19,2% of patients. Most applied biological agent was adalimumab (9,9%), while etanercet was used in 8,8%, infliximab in 8,6% and ustecinumab in 3,5%. No statistically significant difference observed in use of biological agents in different age groups (p>0,05). In this study, parameters such as family history, clinical types, PASI values, nail and joint involvement, comorbidities, dermatosis and applied treatments compared in different age groups of psoriasis patients. Age defined as a statistically significant factor in distribution of clinical types, nail and joint involvement, comorbidities and selection of treatment modalities.
Açıklama
Anahtar Kelimeler
Psoriasis, Farklı Yaş Grupları, Karşılaştırma, Different Age Groups, Comparison
