Skip to main content

Burden of enthesitis on the quality of life and work productivity in psoriatic arthritis patients

Abstract

Background

Psoriatic arthritis (PsA) which affects 6–42% of psoriasis patients is the most common extra-cutaneous manifestation of the psoriasis disease. Enthesitis may be considered as a sign of increased disease burden due to its association with several clinical aspects. Therefore, the aim of the study was to investigate the effect of clinical enthesitis on quality of life and work productivity in PsA patients.

Results

Enthesitis was detected in 50% of patients. There was statistically significant difference between the studied groups as regard disease activity index for psoriatic arthritis (DAPSA) score, psoriatic arthritis impact of the disease 12 (PsAID-12), Health Assessment Questionnaire disability index (HAQ-DI), and Spondyloarthritis Research Consortium of Canada index (SPARCC) with higher mean score in patients with enthesitis. The majority of patients with enthesitis had a higher percentage of impairment in daily activities (95.5%) than those without enthesitis (38.6%), as well as a statistically significant positive correlation between SPARCC index and both work absenteeism and work productivity loss. Furthermore, enthesitis in both the upper and lower sites was related with worse quality of life (36.4%) and higher work impairment (45.5%) compared to patients with enthesitis in either the upper or lower sites alone.

Conclusion

Enthesitis was a frequent complaint among PsA patients. PsA patients with enthesitis had a significant disease burden regardless of enthesitis location, and patients with enthesitis in both the upper and lower sites have a worse quality of life and a higher work impairment.

Background

Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects up to 1% of the population [1]. It is a complex disease involving musculoskeletal disorders (related to the spine, enthesis, and peripheral joints) as well as extra-articular extra-cutaneous manifestations such as gastrointestinal and eye manifestations [2]. PsA, which affects 6–42% of psoriasis patients, is the most common extra-cutaneous manifestation of the disease [3].

Enthesitis, defined as the inflammation of the junction where the tendon, ligament, or joint capsule inserts into the bone [4], has been related to axial and peripheral joint damage, an increased risk of developing joint ankyloses, overall higher disease activity, lower quality of life (QOL) and functional status, sleep disruption, and patient-reported pain and fatigue in PsA patients [5]. As a result, it may be considered as a sign of increased disease burden due to its association with several clinical aspects [6, 7].

Among patients with PsA, enthesitis is known to be resistant to disease-modifying antirheumatic drugs (DMARDs), and it often requires intensive treatment [6]. Therefore, in the present study, we investigated the effect of clinical enthesitis on QOL and work productivity in PsA patients as the impact of the disease’s skin and joint components on QOL and work productivity has previously been studied, but the impact of enthesitis in PsA has been poorly investigated.

Patients and method

This study is a single-center cross-sectional study that included eighty-eight consecutive patients with PsA recruited from the outpatient clinics of rheumatology and rehabilitation and dermatology departments at the university hospital. The study was approved from the university’s local ethical committee and was registered with the following number: ZU-IRP-#9018. Before participation in the study, each patient completed written informed consent.

Inclusion criteria

The patients were included if they were diagnosed with PsA based on the ClASsification criteria for Psoriatic Arthritis (CASPAR) [8].

Exclusion criteria

Patients were excluded if they had another rheumatic disease or any other form of spondyloarthropathy or any disability not related to the disease under the study or associated with coexisting comorbid conditions.

All patient information was collected from medical records with a focus on demographics. This data comprised patient demographics and clinical characteristics (such as the presence and severity of enthesitis, the severity of PsA disease overall, other PsA symptoms encountered, and the patient’s current therapy), and was recorded into a special data file. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) were also measured in the laboratory.

Grouping

The recruited patients were further categorized into two groups according to the presence of enthesitis as the following: group 1, included patients with enthesitis (n = 44), and group 2, included patients without enthesitis (n = 44) as shown in the flowchart (Fig. 1).

Fig. 1
figure 1

Flowchart of the study

Measures

  • Disease activity: Patients were evaluated by using the disease activity in psoriatic arthritis (DAPSA) score. It consists of five untransformed, unweighted variables, including a laboratory variable (CRP in mg/dL), two patient-centered items (patient global assessment; PtGA and pain on an 11-point numeric rating scale; NRS), one physician-centered item (66-swollen joint count; SJC), and one item depending on patient and physician (68-tender joints count; TJC) [9].

  • “Enthesitis assessment: Patients were classified as having clinically defined enthesitis at any site using the Spondyloarthritis Research Consortium of Canada index (SPARCC). Enthesitis index is a measure of enthesitis based on the presence of tenderness at 18 entheseal sites [10]. Each site’s tenderness is reported as either present (1) or absent (0). For scoring purposes, the inferior patella and tibial tuberosity are considered 1 site because of their anatomical proximity. The overall score ranges from 0 to 16; a score of 0 indicates the absence of enthesitis, while a score of 16 indicates the presence of a greater burden of enthesitis. Patients with enthesitis were further classified based on the location of affected sites: upper sites only (medial epicondyle, lateral epicondyle, and supraspinatus insertion into the greater tuberosity of the humerus), lower sites only (greater trochanter, quadriceps tendon insertion into superior border of patella, patellar ligament insertion into inferior pole of patella or tibial tubercle, Achilles tendon insertion into calcaneum, and plantar fascia insertion into calcaneum), and both upper and lower sites.”

  • Health related quality of life: The Arabic version of 36-item Short-Form Health Survey was used which includes eight subscale scores including the physical function, role-physical, bodily pain, energy, health perception, social function, role emotional, and mental health and contains 36 items. The total score ranges from 0 to 100, and higher scores reflect better health status and less disability, where 0 indicates the worst possible health status [11].

  • “Work productivity and activity impairment questionnaire (WPAI) were measured with work limitations questionnaire [12]. It consists of six questions (yes/no) and yields four scores: the percentage of absenteeism (work time missed due to PsA), the percentage of presenteeism (reduced productivity at work due to PsA), an overall work impairment (combines absenteeism and presenteeism), and percentage of impairment in daily activities (outside work activities). WPAI outcomes are expressed as impairment percentages, with higher numbers indicating greater impairment and less productivity.”

  • “Global disability: Physical functional ability was assessed by using the validated Arabic version of the Health Assessment Questionnaire Disability Index (HAQ-DI). ‘It is self-administered contains 20 items divided into 8 domains with each score ranging from 0 (no disability) to 3 (maximal disability).’ Functional disability was defined as a cut-off of the HAQ-DI score ≥ 1 according to preceding studies [13].”

  • Psoriasis Area and Severity Index (PASI): Is the most widely used tool for the measurement of severity of psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease) [14].

  • Psoriatic arthritis impact of disease (PsAID-12): It is as core instrument to measure health-related quality of life in PsA in clinical trials. It measures the difficulty the patient had in doing daily physical activities due to psoriatic arthritis during the last week [15]. It includes 12 domains of health, each assessed by a single question with response on an NRS.

Results

A total 88 PsA patients (33 males and 55 females), with a mean age of 41.03 ± 8.4 years and disease duration of 6.66 ± 3.95 years, were enrolled in this study. There were no statistically significant differences between the studied groups as regard age, age at psoriasis onset, disease duration, body mass index (BMI), gender, smoking, level of education, employment status, arthritis, inflammatory back pain, cervical pain, sacroiliitis, and extra-articular manifestations (Table 1).

Table 1 Demographic, clinical characteristics of patients suffering from psoriasis-related enthesitis and those without enthesitis

Table 2 showed that there were no statistically significant differences between the studied groups as regards PASI score, acute phase reactant (ESR, CRP), number of swollen joints (NSJ), number of tender joints (NTJ), corticosteroids, c-DMARDs, and biological medications. However, there was statistically significant difference between the studied groups as regard DAPSA score, PSAID, and SPARCC index with higher mean score in patients with enthesitis (19.82 ± 6.17), (7.79 ± 1.69), and (7.45 ± 1.93), respectively. NSAID usage was also significantly higher in patients with enthesitis compared to those without.

Table 2 Laboratory results and medications received by patients suffering from psoriasis-related enthesitis and those without enthesitis

As regarding HAQ-DI, there were statistically significant differences between the studied groups with higher mean value in patients with enthesitis (3.23 ± 1.96). Also, there were statistically significant differences between the studied groups as regard SF-36 (total score, physical, role limitation-emotional health (RLEH), fatigue, emotional well-being, social functioning, and general health with higher mean value in patients without enthesitis except for RLEH where the highest mean value was in patients with enthesitis (56.06 ± 13.23). Additionally, there were statistically significant differences between the studied groups as regards WPAI (total score and absenteeism) with higher mean value in patients with enthesitis (50.91 ± 15.52) and (0.68 ± 0.47), respectively (Table 3).

Table 3 Quality of life of patients suffering from psoriasis-related enthesitis and those without enthesitis

Although there were no statistically significant differences in quality-of-life grade between the study groups, about 61.4% of patients without enthesitis reported good quality of life versus 43.2% of those with enthesitis. However, the majority of patients with enthesitis had a higher percentage of impairment in daily activities (95.5%) than those without enthesitis (38.6%) (Table 3).

The distribution of enthesitis sites according to the SPARCC index is shown in Table 4, with Rt. plantar fascia (86.3%) being the most prevalent enthesitis site, followed by Lt Achilles tendon (84.09%), Lt. plantar fascia (79.54%), and Rt. Achilles tendon (72.7%). Patients with both upper and lower limb entheseal site affection had significantly reduced quality of life as measured by SF-36 and impairment in daily activities as measured by WPAI (P ≤ 0.05) (Table 5).

Table 4 Numbers and percentages of entheseal sites involved in the psoriatic arthritis patients with enthesitis according to SPARCC score
Table 5 Quality of life and daily activity impairment in patients suffering from psoriasis-related enthesitis based on the location of SPARCC enthesitis sites

Also, there was a statistically significant positive correlation between NTJ and work productivity loss and a statistically significant positive correlation between PASID12 and absenteeism, as well as a statistically significant positive correlation between SPARCC index and both absenteeism and work productivity loss (Table 6, Figs. 2 and 3). Multivariate analysis revealed that SPARCC index was a significant risk factor for impaired productivity (Table 7).

Table 6 Correlations of work impairment with different disease parameters in PSA patients
Fig. 2
figure 2

Correlation between SPARCC index and work productivity loss

Fig. 3
figure 3

Correlation between SPARCC index and absenteeism

Table 7 Multivariate analysis of risk factors in patients with impaired work productivity

Statistical analysis

All data were collected, tabulated, and statistically analyzed using SPSS 26.0 for windows (SPSS Inc., Chicago, IL, USA). Quantitative data were expressed as the mean ± SD and median (interquartile range), and qualitative data were expressed as absolute frequencies (number) and relative frequencies (percentage). Independent samples Student’s t-test was used to compare between two groups of normally distributed variables, while Mann-Whitney U-test was used for non-normally distributed variables.

Percent of categorical variables were compared using chi-square test or Fisher’s exact test when appropriate. Spearman’s rank correlation coefficient was calculated to assess relationship between various study variables, (+) sign indicates direct correlation, and (−) sign indicates inverse correlation; also, values near to 1 indicate strong correlation, and values near 0 indicate weak correlation. Multivariate logistic regression was done to detect prognostic risk factors for impaired employment. All tests were two sided. P-value ≤ 0.05 was considered statistically significant (S); P-value > 0.05 was considered statistically insignificant (NS).

Discussion

In this study, we analyzed the prevalence of clinical enthesitis in PsA, its association with clinical variables, and its burden on QOL and work productivity. The present study showed that enthesitis was detected in 50% (44/88) of the included PsA patients, in agreement with the findings of previous reports in which the prevalence of enthesitis was as high as 35–50% [1618]. In fact, it is claimed that musculoskeletal ultrasound (US) is a more sensitive diagnostic tool for enthesitis than clinical examination [19]. However, because radiography is inconclusive, enthesitis is frequently evaluated clinically [20], and it is challenging for physicians to include US into their routine practice in PsA due to the time required to assess several enthesopathy sites [21].

Furthermore, patients with active entheseal involvement had higher means of DAPSA score, PSAID, and SPARCC index as well as higher means of WPAI, HAQ-DI, and lower values of most of SF-36 scores. And when we analyzed the QOL and percentage of impairment in daily activities of patients in both groups, we found that about 61.4% of patients without enthesitis had good quality of life versus 43.2% of those with enthesitis. Additionally, most of patients with enthesitis had a higher percentage of disability (95.5%) than those without enthesitis (38.6%). Furthermore, enthesitis in both the upper and lower sites was related with worse quality of life (36.4%) and higher work impairment (45.5%) compared to enthesitis in either the upper or lower sites alone.

Moreover, no statistically significant intergroup differences were detected in terms of demographic and clinical features of patients, as well as PASI score, acute phase reactant (ESR, CRP), NSJ, and NTJ. Other published studies, on the other hand, found that enthesitis was related with extra-articular symptoms (e.g., tenosynovitis and dactylitis), as well as a higher inflamed joint count [17]. Furthermore, several studies have found that individuals with PsA with enthesitis have higher disease activity, worse functional status, and lower quality of life than those without enthesitis [2224].

The disparities in rates might be attributed to variances in the patients’ disease onset profiles, discrepancies in the enthesitis indicators applied, ethnic differences, and changes in the number of patients included in the studies. Furthermore, we did not consider absolute changes in evaluated scores after drug initiation.

Currently, biologic treatments are recommended for patients with severe enthesitis who have failed NSAIDs or local steroid injections [25]. Enthesitis patients used more NSAIDs in this study, but biologic use was equivalent. And it is important to note that 45.5% of enrolled patients are using anti-interleukin-17 (anti-IL-17) in the study population, and it was reported that patients with PsA who received anti-IL-17 agents had statistically greater improvement in their signs and symptoms, including enthesitis, than patients who received a placebo [26].

Regarding work-related factors associated with the development of work restrictions, as measured by the WPAI in PsA patients, there was an association between NTJ and work productivity loss and a positive correlation between PASID12 and absenteeism. This suggests that PsA has a greater impact on patients’ lives and is consistent with previous research showing that joint activity in PsA patients is positively associated with physical functional disability, and it has been claimed that there is a strong relationship between QOL and work productivity, and that absenteeism and presenteeism differ by country due to cultural, economic, and health insurance factors [27].

Interestingly, there was a statistically significant positive correlation between the SPARCC index and both absenteeism and work productivity loss, as well as the linear regression analysis results, indicating that enthesitis, as measured by the SPARCC index, was a significant risk factor for reduced work productivity. Hence, after multivariate analysis, the key findings in the present study were the significant relationship of enthesitis in PsA and work impairment.

The above-mentioned finding matched data from a multinational patient and physician survey in which participants with enthesitis reported a greater impact on work than those without enthesitis, including statistically worse presenteeism, overall work impairment, and activity impairment outside of work [18]. As a result, we would advocate monitoring the level of performance at work while assessing response to treatment in these patients in order to reduce the economic and social burden of absenteeism and presenteeism.

The main limitation of this study was its cross-sectional design, which limited the analysis to enthesitis presence or absence and did not account for absolute changes in score as well as enthesitis assessment was subjective, as we did not use diagnostic US machine. One of the study’s shortcomings is that patients were only recruited from one point of reference, and the cross-sectional design precluded the development of a temporary correlation between the impacts of the parameters assessed and overall work capacity. More data on the effectiveness of PsA therapy for enthesitis and their outcome on the quality of life and work productivity are needed in order to help the clinicians to treat different disease presentations.

Conclusions

Enthesitis was a frequent complaint among PsA patients. PsA patients with enthesitis had a significant disease burden regardless of enthesitis location, and patients with enthesitis in both the upper and lower sites have a worse quality of life and a higher work impairment.

Availability of data and materials

The data will be available upon request.

Abbreviations

Anti-IL-17:

Anti-interleukin-17

Anti-TNF:

Anti-tumor necrosis factors

BMI:

Body mass index

CASPAR:

ClASsification criteria for Psoriatic Arthritis

c- DMARDs:

Conventional disease-modifying antirheumatic drugs

CRP:

C-reactive protein

DAPSA:

Disease activity in psoriatic arthritis disease

ESR:

Erythrocyte sedimentation rate

HAQ-DI:

Health Assessment Questionnaire Disability Index

PsA:

Psoriatic arthritis

QOL:

Quality of life

MTX:

Methotrexate

NSJ:

Number of swollen joints

NTJ:

Number of tender joints

NSAIDs:

Nonsteroidal anti-inflammatory drugs

NRS:

Numeric rating scale

PCS:

Physical component summary

PASI:

Psoriasis Area and Severity Index

PSAID:

Psoriatic Arthritis Impact of disease

PtGA:

Patient global assessment

PASI:

Psoriasis Area and Severity Index

PsAID12:

Psoriatic arthritis impact of disease

RF:

Rheumatoid factor

RLPH:

Role limitation-physical health

RLEH:

Role limitation-emotional

SPARCC index:

Spondyloarthritis Research Consortium of Canada index

SSZ:

Salazopyrine

SF-36:

Short Form 36

US:

Ultrasound

WPAI:

Work productivity and activity impairment questionnaire

References

  1. Mease PJ, Gladman DD, Papp KA, Khraishi MM, Thaçi D, Behrens F et al (2013) Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 69(5):729–735. https://doi.org/10.1016/j.jaad.2013.07.023 Epub 2013 Aug 24. PMID: 23981683

    Article  PubMed  Google Scholar 

  2. Ritchlin CT, Colbert RA, Gladman DD (2017) Psoriatic arthritis. N Engl J Med 376(10):957–970. https://doi.org/10.1056/NEJMra1505557 Erratum in: N Engl J Med. 2017 May 25;376(21):2097. PMID: 28273019

    Article  PubMed  Google Scholar 

  3. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T et al (2005) Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad of Dermatol. 53(4):573. https://doi.org/10.1016/j.jaad.2005.03.046 PMID: 16198775

    Article  Google Scholar 

  4. Watad A, Cuthbert RJ, Amital H, McGonagle D (2018) Enthesitis: much more than focal insertion point inflammation. Curr Rheumatol Rep. 20(7):41. https://doi.org/10.1007/s11926-018-0751-3 PMID: 29846815; PMCID: PMC5976708

    Article  PubMed  PubMed Central  Google Scholar 

  5. Polachek A, Cook R, Chandran V, Gladman DD, Eder L (2017) The association between sonographic enthesitis and radiographic damage in psoriatic arthritis. Arthritis Res Ther 19(1):189. https://doi.org/10.1186/s13075-017-1399-5 Erratum in: Arthritis Res Ther. 2019 Jan 14;21(1):20. PMID: 28810926; PMCID: PMC5558768

    Article  PubMed  PubMed Central  Google Scholar 

  6. Coates LC, Kavanaugh A, Mease PJ, Soriano ER, Laura Acosta-Felquer M, Armstrong AW et al (2016) Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol. 68(5):1060–1071. https://doi.org/10.1002/art.39573 Epub 2016 Mar 23. PMID: 26749174

    Article  PubMed  Google Scholar 

  7. Sunar I, Ataman S, Nas K, Kilic E, Sargin B, Kasman SA et al (2020) Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study. Rheumatol Int. 40(2):283–294. https://doi.org/10.1007/s00296-019-04480-9 Epub 2019 Nov 26. PMID: 31773391

    Article  PubMed  CAS  Google Scholar 

  8. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 54(8):2665–2673. https://doi.org/10.1002/art.21972 PMID: 1687153

    Article  PubMed  Google Scholar 

  9. Nell-Duxneuner VP, Stamm TA, Machold KP, Pflugbeil S, Aletaha D, Smolen JS (2010) Evaluation of the appropriateness of composite disease activity measures for assessment of psoriatic arthritis. Ann Rheum Dis. 9(3):546–549. https://doi.org/10.1136/ard.2009.117945 Epub 2009 Sep 17. PMID: 19762363

    Article  Google Scholar 

  10. Maksymowych WP, Mallon C, Morrow S, Shojania K, Olszynski WP, Wong RL et al (2009) Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index. Ann Rheum Dis. 68(6):948–953. https://doi.org/10.1136/ard.2007.084244 Epub 2008 Jun 4. PMID: 18524792

    Article  PubMed  CAS  Google Scholar 

  11. Guermazi M, Allouch C, Yahia M, Huissa TB, Ghorbel S, Damak J et al (2012) Translation in Arabic, adaptation and validation of the SF-36 Health Survey for use in Tunisia. Ann Phys Rehabil Med. 55(6):388–403. https://doi.org/10.1016/j.rehab.2012.05.003 Epub 2012 Jun 21. PMID: 22795246

    Article  PubMed  CAS  Google Scholar 

  12. Lerner D, Amick BC 3rd, Rogers WH, Malspeis S, Bungay K, Cynn D (2001) The work limitations questionnaire. Med Care. 39(1):72–85. https://doi.org/10.1097/00005650-200101000-00009 PMID: 11176545

    Article  PubMed  CAS  Google Scholar 

  13. Intriago M, Maldonado G, Guerrero R, Moreno M, Moreno L, Rios C (2020) Functional disability and its determinants in Ecuadorian patients with rheumatoid arthritis. Open Access Rheumatol. 12:97–104. https://doi.org/10.2147/OARRR.S251725 PMID: 32607017; PMCID: PMC7293966

    Article  PubMed  PubMed Central  Google Scholar 

  14. Langley RG, Ellis CN (2004) Evaluating psoriasis with Psoriasis Area and Severity Index, Psoriasis Global Assessment, and Lattice System Physician's Global Assessment. J Am Acad Dermatol. 51(4):563–569. https://doi.org/10.1016/j.jaad.2004.04.012 PMID: 15389191

    Article  PubMed  Google Scholar 

  15. Holland R, Højgaard P, Tillett W, Wit M, Gossec L, Christensen R et al (2020) Evidence for psoriatic arthritis impact of disease (PsAID12) as core instrument to measure health-related quality of life in psoriatic arthritis: a systematic review of psychometric properties. J Psoriasis Psoriatic Arthritis. 5(1):12–22. https://doi.org/10.1177/2475530319890832

    Article  Google Scholar 

  16. Kaeley GS, Eder L, Aydin SZ, Gutierrez M, Bakewell C (2018) Enthesitis: a hallmark of psoriatic arthritis. Semin Arthritis Rheum. 48(1):35–43. https://doi.org/10.1016/j.semarthrit2017.12.008 PMID: 29429762

    Article  PubMed  Google Scholar 

  17. Polachek A, Li S, Chandran V, Gladman DD (2017) Clinical enthesitis in a prospective longitudinal psoriatic arthritis cohort:incidence, prevalence, characteristics, and outcome. Arthritis Care Res 69(11):1685–1691. https://doi.org/10.1002/acr.23174 Epub 2017 Sep 21. Erratum in: Arthritis Care Res (Hoboken). 2019 Apr;71(4):574. PMID: 27998023

    Article  Google Scholar 

  18. Orbai AM, Birt JA, Holdsworth EA, Booth N, Malatestinic WN, Sprabery AT et al (2020) Impact of enthesitis on psoriatic arthritis patient-reported outcomes and physician satisfaction with treatment: data from a multinational patient and physician survey. Rheumatol Ther 7(4):937–948. https://doi.org/10.1007/s40744-020-00242-3 Epub 2020 Oct 14. PMID: 33052584; PMCID: PMC7695789

    Article  PubMed  PubMed Central  Google Scholar 

  19. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 61(10):905–910. https://doi.org/10.1136/ard.61.10.905 PMID: 12228161; PMCID: PMC1753913

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Weckbach S, Schewe S, Michaely HJ, Steffinger D, Reiser MF, Glaser C (2011) Whole-body MR imaging in psoriatic arthritis: additional value for therapeutic decision making. Eur J Radiol. 77(1):149–155. https://doi.org/10.1016/j.ejrad.2009.06.020 Epub 2009 Jul 24. PMID: 19632076

    Article  PubMed  Google Scholar 

  21. Kristensen S, Christensen JH, Schmidt EB, Olesen JL, Johansen MB, Arvesen KB et al (2016) Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound. Muscles Ligaments Tendons J. 6(2):241–247. https://doi.org/10.11138/mltj/2016.6.2.241 PMID: 27900299; PMCID: PMC5115257

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mease PJ, Karki C, Palmer JB, Etzel CJ, Kavanaugh A, Ritchlin CT et al (2017) Clinical characteristics, disease activity, and patient-reported outcomes in psoriatic arthritis patients with dactylitis or enthesitis: results from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. Arthritis Care Res. 69(11):1692–1699. https://doi.org/10.1002/acr.23249 PMID: 28376239

    Article  CAS  Google Scholar 

  23. Gezer O, Batmaz I, Sariyildiz MA, Sula B, Ucmak D, Bozkurt M et al (2017) Sleep quality in patients with psoriatic arthritis. Int J Rheum Dis. 20(9):1212–1218. https://doi.org/10.1111/1756-185X.12505 Epub 2014 Nov 1. PMID: 25363664

    Article  PubMed  CAS  Google Scholar 

  24. Baskan B, Oten E, Sivas F, Eser F, Yurdakul FG, Duran S et al (2016) The relationship between vitamin D, vertebral deformity and quality of life in psoriatic arthritis. Acta Reumatol Port. 41(4):350–358 English. PMID: 27155167

    PubMed  Google Scholar 

  25. Gossec L, Smolen JS, Gaujoux-Viala C, Ash Z, Marzo-Ortega H, van der Heijde D et al (2012) European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann Rheum Dis. 71(1):4–12. https://doi.org/10.1136/annrheumdis-2011-200350 Epub 2011 Sep 27. PMID: 21953336

    Article  PubMed  CAS  Google Scholar 

  26. Atzeni F, Carriero A, Boccassini L, D'Angelo S (2021) Anti-IL-17 agents in the treatment of axial spondyloarthritis. Immunotargets Ther. 10:141–153. https://doi.org/10.2147/ITT.S259126 PMID: 33977094; PMCID: PMC8104974

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Kennedy M, Papneja A, Thavaneswaran A, Chandran V, Gladman DD (2014) Prevalence and predictors of reduced work productivity in patients with psoriatic arthritis. Clin Exp Rheumatol. 32(3):342–348. Epub 2014 Apr 7. PMID: 24708934

Download references

Acknowledgements

Declared none

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

Authors

Contributions

All authors have contributed to designing the study, collecting and analyzing, interpretation of data, and preparing and revising the manuscript. Design of the study, DF, WK and RZ. Recruitment of patients, DF, WK and RZ. Data collection, DF, WK and RZ. Manuscript preparation and revision, DF, WK and RZ. All co-authors have approved the final manuscript.

Corresponding author

Correspondence to Rabab S. Zaghlol.

Ethics declarations

Ethics approval and consent to participate

An approval was obtained from the ethics committee of the Faculty of Medicine, Zagazig University, and the approval number was ZU-IRB#9018. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Informed written consents were obtained from all patients.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fahmi, D.S., Makarm, W.K. & Zaghlol, R.S. Burden of enthesitis on the quality of life and work productivity in psoriatic arthritis patients. Egypt Rheumatol Rehabil 49, 58 (2022). https://doi.org/10.1186/s43166-022-00157-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s43166-022-00157-7