Psoriatic Arthritis Associated With Vestibular and Hearing Disorders

Assessing a patient’s sense of balance and hearing ability may be an aid in diagnosing psoriatic arthritis.

Psoriatic arthritis is a chronic, inflammatory rheumatic disease that is difficult to distinguish from rheumatoid arthritis. However, one of the hallmarks of psoriatic arthritis is the constellation of vestibular impairment abnormalities associated with the condition.

On September 1, 2014, researchers Amor-Dorado et al published a study in The Journal of Rheumatology evaluating the relationship between impaired balance, vertigo, and other audiovestibular manifestations of psoriatic arthritis.

Investigators assessed a series of 60 patients who met the diagnostic criteria for psoriatic arthritis and 60 matched control patients, using an audiogram and a validated assessment of balance known as computerized dynamic posturography. To exclude potential causes outside of psoriatic arthritis, investigators left out patients with cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere disease, and users of potentially ototoxic medications.

Of the 60 patients with psoriatic arthritis, more than half (60%) showed signs of hearing loss on an audiogram versus 8.3% of matched controls (P <.001). In addition, nearly one-fourth (23%) of patients with psoriatic arthritis showed signs of difficulty balancing, compared with 0% of control patients (P <.001).

The disease process of psoriatic arthritis may cause inner ear damage that may harm patients' ability to maintain balance and normal hearing. Because psoriatic arthritis is often difficult to distinguish from rheumatoid arthritis, vestibular symptoms may be 1 way to aid in distinguishing these 2 separate conditions. With the availability of treatments such as apremilast that target the disease process of psoriatic arthritis, the distinction between rheumatoid arthritis and psoriatic arthritis is more relevant than ever.

Reference:

Amor-Dorado JC, Barreira-Fernandez MP, Pina T, Vázquez-Rodríguez TR, Llorca J, González-Gay MA. Investigations into Audiovestibular Manifestations in Patients with Psoriatic Arthritis. J Rheumatol.2014.