Psoriatic arthritis and human immunodeficiency virus infection in Zambia

To characterize the clinical features of psoriatic arthritis (PsA) in black Zambians and the association of PsA with human immunodeficiency virus (HIV) infection.

Patients attending an arthritis clinic in a 40 month period who exhibited psoriasiform lesions were assessed clinically and tested for the presence of antibodies to HIV.

Of 702 new attendees with inflammatory arthritis 28 were designated as PsA and 27 of these were HIV+. Sixteen patients (60%) at presentation were in WHO clinical stage I (no disease or lymphadenopathy alone) compared to 2 in stage 4 (acquired immune deficiency syndrome, AIDS). Arthritis and psoriasis developed simultaneously in 20 patients. The arthritis is predominantly polyarticular, lower limb, and progressive. Amelioration was noted with onset of AIDS. Psoriasis was commonly an extensive guttate-plaque admixture and nonremittive with onset of AIDS.

PsA is almost universally associated with HIV infection in black Zambians. The clinical features are similar to those described in Caucasians with HIV associated PsA.