Ethics approval and consent to participate The CONSORT flow diagram was added as supplement 1. Sample size: regarding previous studies, a total of 80 are required to achieve 80% study power at 95% confidence level with a margin of error equal to 5%. Patients with other dermatological disorders, history of schizophrenia, major depression, other diagnosed psychiatric disorders, and patients on psychotropic drugs were excluded.ĭuration of the study: 11 months (from Jan 2021 to Dec 2021). PatientsĮighty patients meeting CASPAR criteria for PsA and 80 healthy volunteers matched for age and gender were included in the study (the healthy control were selected from personnel who work in the hospital and the apparently healthy persons who accompanied the patients). Patients were selected from the outpatient clinic of Rheumatology and Rehabilitation department, Tanta University Hospitals. This is a single-center case–control study. The aim of this study was to assess the serum levels of interleukin-23 in PsA patients and its correlation with depression, anxiety, and disease activity. Interleukin-23 is a proinflammatory cytokine which is involved in the pathophysiology of spondyloarthropathies including psoriatic arthritis and is responsible for many clinical features in PsA. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. Some existing literature discussed that the proinflammatory cytokines could be elevated in both psoriasis/PsA and depression, which may indicate that the inflammatory process might be involved in the progression of both PsA and depression. The presence of joint and skin disease in PsA patients may increase the risk for depression and anxiety. The prevalence of depression in patients with psoriasis ranges from 19.2 to 62% and anxiety is reported to be as high as 43%. In PsA, psychological disorders can both cause and exacerbate disease development. The psychosocial burden of PsA has been shown to have a negative effect on the quality of life of the patients. Psoriatic disease is frequently limited to the core clinical domains of skin psoriasis, nail involvement, peripheral inflammatory arthritis, axial spondyloarthritis, enthesitis, and dactylitis, while its numerous systemic consequences and comorbidities are ignored. It is a chronic, progressive, inflammatory arthritis associated with cutaneous psoriasis that can potentially affect multiple organ systems. Psoriatic arthritis (PsA) affects 0.3 to 1% of the general population and up to 30% of patients with psoriasis. Serum interleukin-23 levels were elevated in PsA patients and were found to be correlated with depression, anxiety, and disease activity. IL-23 was positively correlated with DAPSA, PASI, and HADS scores we observed that interleukin 23, higher DAPSA, and PASI were independently associated with depression and anxiety. There were significant differences in HADS anxiety and depression scores between patients and controls with significant positive correlations between HADS depression, anxiety scores and IL-23, DAPSA, PASI, and MASEI scores ( p < 0.05). Thirty-six PsA patients (45%) had anxiety and 28 patients (35%) had depression, while in the control group, 16 persons (20%) had anxiety and 12 (15%) had depression, with significant differences between the 2 groups ( p < 0.0001). There was no significant difference between patients and controls regarding demographic data. Serum IL-23 was measured and correlated with disease activity, depression, and anxiety. Depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HADS). All participants suspected to detailed history, clinical assessment, PsA activity using Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the severity and extent of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI), and ultrasonographic assessments of the entheses were examined according to the Madrid Sonographic Enthesitis Index (MASEI). MethodsĮighty psoriatic arthritis (PsA) patients and eighty healthy volunteers matched for age and gender were included in this observational case–control study. Assessment of serum levels of IL-23 in PsA patients and its correlation with depression, anxiety, and disease activity.
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