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Background: Psoriasis ( P ) may be complicated by psoriatic arthritis (psoriatic arthropathy ( PsA ), in 15 % of psoriatic patients [1]. The risk of mortality is increased in PsA outpatients compared to the general population [2].
Objectives: The aim of this study was to determine the mortality of PsA or associated diseases in an in-patient autopsy population.
Methods: At the National Institute of Rheumatology 11860 patients died between 1968 and 1998; among them 12 patients with PsA ( females 6. mean age of 68.17 years, range 86 – 52, onset of PsA 53.60, average duration of PsA 15.40 years; males 6, mean age of 62.83 years, range 82 – 33, onset of PsA 46.67, average duration of PsA 3.67 years). All patients were autopsied.
The basic disease, complication(s), and cause of death were determined by a detailed review of extensive histological material, all the available clinical and pathological reports retrospectively. From each patient a total of 50-100 tissue blocks of 16 organs were studied microscopically.
PsA was confirmed clinically according to the criteria of the ACR updated by Sukfa (2019) [1].
Results: The cause of death was related to PsA only in one (8.33 %) of 12 patients; a 33 year old man who died of pulmonary embolism after synovectomy.
In
11
(91.66 %) of 12
PsA
patients the cause of death was related to allied diseases namely
atherosclerosis
(
Ath
) in
9
(75 %),
tuberculosis
complicated by miliary dissemination (
TB
-
mTB
) in
1
(8.33 %), and
alcoholic cirrhosis
(
AC
) in
1
(8.33 %).
Ath
was complicated by hypertension (
HT
) and adult type diabetes mellitus (
DM
) in 4, was associated with
TB
in 1 and with
AC
in 1 of 9 patients;
HT
and
DM
were present in one
PsA
patient without
Ath
(
AA amyloidosis ( AAa ) complicated PsA in 2 (16.66 %) of 12 PsA patients; in one case due to the long standing and severe inflammation of PsA , and in the other case the AAa was associated with TB and mTB .
| P-PsA | Basic disease (leading to death) | Complication(s) | Cause of death | |
| 1 | P-PsA | Ath, TB | Adhesive pericarditis and pleuritis | Circulatory failure |
| 2 | P-PsA | Ath-HT-DM Hyperplasic prostate | Postoperative complication | Pulmonary embolism |
| 3 | P-PsA | Ath-HT-DM | Brain necrosis, Pulmonary embolism | Circulatory failure |
| 4 | P-PsA | Ath | Purulent bronchitis-Bronchopneumonia | Circulatory failure |
| 5 | P-PsA | TB-mTB | AAa, Arosion bronchial artery | Massive bronchial bleeding |
| 6 | P-PsA | Ath | AAa, Coronary artery thrombosis | Myocardial infarction |
| 7 | P-PsA | Synovectomy | Pulmonary embolism | |
| 8 | P-PsA | Ath-HT-DM | Coronary artery thrombosis | Myocardial infarction |
| 9 | P-PsA | Ath | Myocardial fibrosis | Circulatory failure |
| 10 | P-PsA | Ath, Alcoholic cirrhosis | Ascites, Purulent bronchitis | Circulatory failure |
| 11 | P-PsA | Alcoholic cirrhosis, HT-DM | Ascites | Hepatorenal syndrome |
| 12 | P-PsA | Ath-HT-DM | Myocardial fibrosis | Circulatory failure |
Conclusion: In our autopsy population Ath (with or without HT and DM ) was the most important basic disease leading to circulatory failure and death of PsA patients.
Diseases of the circulatory system were also the most common cause of death in Wong’s outpatient PsA population as well [2].
PsA is not a mild disease, but is not a life-threatening complication of P , however in association with Ath , HT , DM or TB it may increase mortality, as was also found by Arumugam and McHugh (2012): ‘the mortality of PsA may be increased in a more severe disease’ [3].
REFERENCES:
[1]
Sukfa P
(2019)
[2]Wong K, et al: Arth Rheum 1997; 40(10):1868-1872 PMID: 9336423
[3]Arumugam R, McHugh NJ: J Rheumatol Suppl , 2012; 89:32-5. doi: 10.3899/jrheum.120239
Disclosure of Interests: None declared.