Psoriasis would be a typical, genetically determined chronic, relapsing, inflammatory disorder of the skin characterised by red, scaly, sharply demarcated plaques that typically exhibit silvery-white scales.

Psoriasis is one of the significant common chronic inflammatory diseases of the skin, affecting 2–3% of the population [1]. The authors defined PsA as " inflammatory arthritis associated with psoriasis and negative for serum autoantibody." Some scientists refused to accept this definition, believing that the condition can coexist with two diseases: Arthritis (rheumatoid) and psoriasis. Psoriatic arthritis is a disease during which the cutaneous manifestation of psoriasis coexists with arthritis, usually within the absence of autoantibody.

The estimated prevalence of atrophic arthritis among patients with psoriasis is 4–42% (typically 7–10%) [2]. in additional recent studies, the prevalence of PsA is more often reported to be approximately 30% among patients with psoriasis, giving an overall prevalence of 0.3–1.0% within the general population [3-5]. Different clinical classifications are proposed for PsA since the initial subtypes were described in 1973; however, the foremost recent was developed by a world multicentre study leading to the CASPAR criteria and has now been widely adopted [6].

Psoriatic Arthritis (PsA) could be chronic inflammatory arthritis of unknown etiology, and currently, the cellular and molecular interactions that dictate its pathogenesis remain elusive. A task of the interleukin-23 (IL-23)/IL-23R (IL-23 receptor) interaction within the development of psoriasis and PsA is well established. As IL-23 regulates the differentiation and activation of innate and adaptive immunity, it pertains to complex pathophysiology involving a plethora of effectors and transducers. The positive effect of treatment in PsA depends on its early initiation before progressive joint destruction occurs. Modern diagnostic imaging techniques play an outsized role, especially in mildly symptomatic cases.

This study was planned at the Department of Skin and V.D., BRD Medical College Gorakhpur because no study was available on this topic in the eastern part of Uttar Pradesh and this medical college located in the east part of Uttar Pradesh with a sufficient number of cases, reported in the O.P.D. of the department and has adequate infrastructure.

The percentage area affected by psoriasis is evaluated in the four regions of the body. In each region, the area is expressed as nil (0), 1-9% (score 1), 10-29% (score 2), 30-49% (score 3), 50-69% (score 4), 70-89% (score 5) or 90-100% (score 6).

• Head and neck
• Upper limbs
• Trunk
• Lower limbs

Each patient has undergone the following investigation.

1. Routine blood tests
2. Liver function test, kidney function test (if required)
3. Skin biopsy
4. Tests for Rheumatoid factor and serum uric acid.
5. Radiographs of both hands and feet.
6. Radiographs of the lumbosacral Spine and both sacroiliac joints.
7. Radiographs of affected joints (if any).

Table 2 shows that the total number of psoriatic arthritis cases was found 26, in which males were 17 and females were 9. The maximum number of cases was in the age group 41-50 in male, while in female 31- 40 years.

Table 3 shows a maximum number of arthritis cases of 18.05% were seen with severe disease (PASI score > 15) in both male and female groups. Minimum numbers of arthritis cases 3.89 % were seen with mild disease (PASI score 0-3).

Table 4: Joint Involvement

Table 4 shows the maximum number of joints involved distal interphalangeal joint 69.2 3% and the minimum number of joints involved it was significant joint 7.69%.

Table 5: Radiological changes in upper and lower limb

Table 5 shows maximum radiological changes were seen in marginal erosion of distal interphalangeal joint 23.1 7%, and calcaneum spur was seen in 3.84 %.

Table 6: Radiological changes of Sacroiliac joint and Spine

Distal interphalangeal (D.I.P.) joint arthropathy is characteristic of both rheumatism (PsA) and osteoarthritis (O.A.), PsA is also distinguished from O.A. on the premise of more severe inflammation within the collateral ligaments and also the extensor tendons and more severe changes at the corresponding D.I.P. joint entheseal insertions. Swelling related to D.I.P. PsA usually affects the whole finger or toe. It's asymmetric, meaning it affects only one side of the body, which means that if all the joints in one hand are affected, the opposite hand might not be affected in the slightest degree, or four or fewer digits are involved.

However, research shows PsA can even be symmetrical, involving the joints on either side of the body.2 Moreover, D.I.P. PsA occurs more frequently within the toes [11]. Previously many authors [12,13] reported Distal interphalangeal (D.I.P.) joint arthropathy is highest among other joints. Our findings support the previous study because the maximum number of joints involved distal ginglymus was 69.2 3%, and also the minimum number of joints involved had been significant joint 7.69%. D.I.P. rheumatism also causes Enthesitis, inflammation at the places where ligaments and tendons meet at the bones. The kind of swelling and inflammation can erode the joints and result in deformity and loss of function.

Bone erosions were smitten by age and disease duration of PsA. Erosions reflect accumulating mechanical and inflammatory damage within the joints. In accordance, erosive damage was most significant in patients with PsA. No difference was found between healthy controls and patients with PSO. a noteworthy finding was that with an increase in age, bone erosions failed to only increase in patients with PsA, but also in patients with PSO and healthy controls. While individuals without inflammatory joint disease (healthy controls and patients with psoriasis) ;presumably accrue damage because of mechanical triggers, in patients with PsA the extra inflammatory trigger appears to hurry up erosions.

Hence, the common 20 to 40-year old patient with PsA already exhibits a burden of bone erosions, which equals that of a private who is over 60 years old and doesn't have inflammatory joint disease. These findings also indicate that judgement on the burden of erosive bone damage in private with PsA must consider age as a significant influencing factor.

Dr Kamlesh Kumar Bhaskar: Major contribution and performed all methods as a junior resident in this study.

Dr Rakesh Kumar Shukla: Major contribution and wrote the manuscript.

Dr. Rajesh Kumar Rai: Statistical analysis and data interpretation.

Dr Archana Mishra: Data Analysis and Review

Dr Kavita Chawla: Data Analysis and Review

Disclosure

The authors declare that there is no conflict of interest.