Abstract：
Of those patients diagnosed with generalized pustular psoriasis (GPP) in Japan, approximately 30% have a prior psoriasis vulgaris (PsV) diagnosis. Therefore, understanding factors associated with a GPP diagnosis is essential for early diagnosis of GPP in patients with PsV. This retrospective cohort study was conducted to identify associated factors for GPP diagnosis in patients with PsV. Eligible patients with two confirmed diagnoses of PsV with/without a confirmed GPP diagnosis (International Classification of Disease 10th revision codes L40.0 and L40.1, respectively) were identified from the Japanese Medical Data Center database (JMDC) (July 1, 2005-January 31, 2019). Weighted logistic regression was used to identify associated factors (based on recorded comorbidities) between the PsV only and PsV with GPP cohorts. Odds ratios (ORs) of ≥1.5, associated with a high probability of a GPP diagnosis, were reported for factors with ≥5 patients/cohort. The time from event to GPP diagnosis was evaluated. The highest associated factor for GPP diagnosis was psoriatic arthritis (OR 20.2, 95% confidence interval [CI] 17.06-23.92, P < 0.0001), which also had the shortest time from event to GPP diagnosis (median 119 days). Other comorbidities associated with GPP diagnosis were other psoriasis, tonsillitis, and sinusitis. Treatments associated with GPP diagnosis included systemic corticosteroids (OR 2.19, 95% CI 1.98-2.43, P < 0.0001; median time from treatment initiation to GPP diagnosis 180 days). Other associated treatments (other immunosuppressants, interleukin [IL]-17 or IL-23 inhibitors, and phototherapy) had a delay of ≥1 year from treatment initiation to GPP diagnosis. Back pain, headache, and fever were also identified as associated with a GPP diagnosis. Patients with PsV requiring systemic therapies are more likely to receive a GPP diagnosis than those not requiring systemic treatment. These data will help identify patients with PsV at high risk of developing GPP and potentially support early GPP diagnosis.
摘要：
在日本被诊断为全身性脓疱型银屑病（3GPP）的患者中，大约30％的人先前有寻常型银屑病（PsV）诊断。因此,了解与3GPP诊断相关的因素对于PsV患者的3GPP的早期诊断至关重要。进行这项回顾性队列研究，以确定PsV患者的3GPP诊断的相关因素。从日本医学数据中心数据库（JMDC）（2005年7月1日-2019年1月31日）中确定了有或没有确诊3GPP诊断的两种确诊的PsV诊断（国际疾病分类第10次修订代码分别为L40.0和L40.1）的合格患者。使用加权逻辑回归来确定仅PsV和PsV与3GPP队列之间的相关因素（基于记录的合并症）。赔率(ORs)≥1.5，与3GPP诊断的高概率相关，报告了≥5名患者/队列的因素。评估从事件到3GPP诊断的时间。提示诊断的最高相关因素是银屑病关节炎(OR20.2,95%可信区间[CI]17.06-23.92,P<0.0001),从事件到3GPP诊断的时间也最短(中位数119天).与3GPP诊断相关的其他合并症是其他牛皮癣，扁桃体炎,和鼻窦炎.与3GPP诊断相关的治疗包括全身性皮质类固醇（OR2.19，95％CI1.98-2.43，P<0.0001；从治疗开始到3GPP诊断180天的中位时间）。其他相关治疗（其他免疫抑制剂，白细胞介素[IL]-17或IL-23抑制剂，和光疗）从治疗开始到3GPP诊断延迟≥1年。背痛,头痛,发热也被确定为与3GPP诊断相关。需要全身性治疗的PsV患者比不需要全身性治疗的患者更有可能接受3GPP诊断。这些数据将有助于识别患有PsV的患者，这些患者具有发展为3GPP的高风险，并可能支持早期的3GPP诊断。
