Rheumatology, Vol 38, 332-337, Copyright © 1999 by British Society for Rheumatology
S Marsal, L Armadans-Gil, M Martinez, D Gallardo, A Ribera and E Lience
OBJECTIVE: The aim of this study was to examine whether the five clinical
forms of psoriatic arthritis (PsA) identified by Moll and Wright (Semin
Arthritis Rheum 1973;3:55-78) could be clearly distinguished, especially as
the disease evolved over time, to analyse whether radiographic features or
HLA associations could define subsets with greater precision and to
identify predictors of disease outcome. METHODS: Seventy-three patients (37
males and 36 females) were followed for a median time of 8 yr (range 1-16
yr). A standard clinical protocol was used to assess patients at each visit
and two clinical scores. based on the joint areas involved, were defined to
evaluate the mode of onset and the evolution of arthritis. X-ray films of
the hands, feet and sacroiliac joints were taken and the patients were
divided into two categories according to the presence or absence of
erosions and an X- ray erosion score was also used. Three classification
methods were used to define the different clinical subsets. HLA-A, B and DR
antigens were tested by standard microlymphocytotoxicity assays. A multiple
linear regression model was used in the statistical analysis. RESULTS: The
five classical clinical subsets defined by Moll and Wright did not remain
since distinct peripheral arthritis patterns tended to evolve over time.
Only two discrete groups were identified, axial disease (AD) (sacroilitis
with or without peripheral arthritis) in 29% of cases and peripheral
disease (PD) without sacroilitis in 71%. AD was positively associated with
the duration of arthritis (P < 0.04), presence of mutilation (P <
0.02) and the joint area score over disease evolution (JASE) (P < 0.02).
There were erosions in 71% of the patients. Erosions correlated with the
presence of mutilation (P < 0.007) and with the JASE (P < 0.0005).
HLA-B27 was found in 43% of patients with AD, but only in 11% of PD
patients (P < 0.01). No other clear HLA correlations were found.
CONCLUSIONS: Despite the relatively small number of patients, this
longitudinal study suggests that only two clinical subsets can be clearly
defined in PsA, AD and PD; these are primarily determined on clinical
grounds although HLA-B27 is strongly associated with AD. The evolution of
PD pattern with time means that narrower peripheral arthritis subsets are
of little clinical use.
ORIGINAL PAPERS
Clinical, radiographic and HLA associations as markers for different patterns of psoriatic arthritis
Section of Rheumatology, Vall d'Hebron Hospitals, Barcelona, Spain.
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