Orthopedic Manifestations in Patients with Psoriasis: A Hospital-based Cross-sectional Study

Psoriasis is a chronic inflammatory skin disorder frequently associated with extracutaneous manifestations, particularly involving the musculoskeletal system. Orthopedic involvement contributes substantially to morbidity but often remains underdiagnosed. This study aimed to evaluate the prevalence and pattern of musculoskeletal manifestations in patients with psoriasis and to assess their association with clinical disease characteristics.

A hospital-based cross-sectional study was conducted among 180 adult patients with clinically confirmed psoriasis attending a tertiary care center. Demographic details, disease duration, clinical type of psoriasis, nail involvement, and disease severity assessed by the psoriasis area and severity index (PASI) were recorded. All patients underwent a structured orthopedic evaluation for musculoskeletal manifestations. Laboratory parameters and radiological investigations were performed where indicated. Data were analyzed using appropriate statistical tests, with a P < 0.05 considered statistically significant.

The mean age of participants was 42.6 ± 11.8 years, with males constituting 62.2% of the study population. Musculoskeletal involvement was observed in 54 patients (30.0%). Peripheral joint involvement was the most common pattern (17.8%), followed by axial (6.7%) and combined peripheral and axial involvement (5.6%). The knee (48.1%) and ankle (40.7%) were the most frequently affected joints. Enthesitis and dactylitis were present in 10.0% and 7.8% of patients, respectively. Musculoskeletal involvement was significantly associated with longer disease duration (≥5 years), nail involvement, and moderate to severe psoriasis (PASI ≥10) (P < 0.05). Elevated erythrocyte sedimentation rate and C-reactive protein were noted in 59.3% and 51.9% of affected patients, respectively, while 44.4% showed radiographic abnormalities.

Musculoskeletal manifestations affect a substantial proportion of patients with psoriasis and are significantly associated with disease severity, duration, and nail involvement. Routine screening for orthopedic involvement should be integrated into the clinical evaluation of patients with psoriasis to enable early diagnosis and appropriate management.