Rheumatology Advance Access originally published online on October 1, 2003
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Rheumatology 2003; 42: 1460-1468
© 2003 British Society for Rheumatology
A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience
Department of Rheumatology, St. Vincent’s University Hospital, Dublin 4, Ireland.
Correspondence to:
D. Kane, Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow G31 2ER, UK. E-mail: david.kane{at}ucd.ie
Objective. To determine the clinical presentation and clinical and radiological outcome of early psoriatic arthritis (PsA) at 1 and 2 yr.
Methods. Patients with PsA were assessed at the St. Vincent’s University Hospital Early Synovitis Clinic. Standardized clinical and laboratory assessment was performed at presentation and 1- and 2-yr follow-up. Radiographs of the hands and feet were evaluated in chronological order by two trained observers using the Sharp method modified to include the distal interphalangeal (DIP) joints.
Results. A total of 129 (12.7%) of 1018 patients were diagnosed with PsA [mean age at onset of arthritis was 40.4 yr (range 11–76); mean duration of disease was 9.9 months (range 0.3–48); 52 oligoarticular, 77 polyarticular]. Means and standard deviations of indices of disease activity at presentation were: 10-cm visual analogue scale = 4.8 ± 2.7, HAQ score = 0.71 ± 0.64, ACR functional class III/IV = 41 (35%), Ritchie Articular Index = 5.6 ± 6, swollen joint count = 6.9 ± 8, erythrocyte sedimentation rate = 24 ± 26.4 mm/h, C-reactive protein = 27.6 ± 58.5 mg/l. At presentation, 49 (38%) patients had peripheral enthesopathy, 13 patients (10%) had inflammatory spine pain and 50 (39%) patients had DIP involvement. A total of 119 had psoriasis at the time of presentation [plaque psoriasis in 112 (94%), mean age of psoriasis onset was 29.8 ± 16.2 yr, nail dystrophy present in 78 patients (67%)]. At 1 yr of follow-up, 119 (92%) patients were reassessed and 70 (59%) were taking a disease-modifying anti-rheumatic drug (DMARD). At 2 yr, 97 (75%) patients were reassessed and 54 (56%) were taking a DMARD. Despite considerable improvement in inflammation and function scores, only 31 (26%) patients were in remission at 1 yr with 20 (21%) in remission at 2 yr. There was a low rate of DMARD-free remission [14 (12%) at 1 yr and 11 (11%) at 2 yr]. Radiographs of hands and feet were obtained for 117 (91%) patients at presentation and 86 (67%) patients at a median follow-up of 24 months (range 11–56); 47% of patients had joint erosions in hands or feet at follow-up with a mean Sharp erosion score of 3 (0) ± 5.2 (range 0–25) and a mean Sharp narrowing score of 3.2 (0) ± 7.5 (range 0–48).
Conclusion. This study confirms that PsA is a chronic, progressive disease in the majority of patients. Despite clinical improvement with current DMARD treatment, PsA results in radiological damage in up to 47% of patients at a median interval of 2 yr.
KEY WORDS: Psoriatic arthritis, Clinical presentation, Clinical outcome, Radiological outcome, Early synovitis clinic.
Dr Leanne Stafford tragically died before the publication of this work.
Reprint requests to: O. FitzGerald, Department of Rheumatology, St. Vincent’s University Hospital, Dublin 4, Ireland. E-mail: ofitzger@iol.ie
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J A Husted, B D Tom, C T Schentag, V T Farewell, and D D Gladman Occurrence and correlates of fatigue in psoriatic arthritis Ann Rheum Dis, October 1, 2009; 68(10): 1553 - 1558. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. D. GLADMAN Psoriatic Arthritis from Wright's Era Until Today J Rheumatol Suppl, August 1, 2009; 83(0): 4 - 8. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. ROBINSON, S. KELLY, and C. PITZALIS Basic Synovial Biology and Immunopathology in Psoriatic Arthritis J Rheumatol Suppl, August 1, 2009; 83(0): 14 - 16. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. SCARPA, M. ATTENO, L. COSTA, R. PELUSO, S. IERVOLINO, F. CASO, and A. D. PUENTE Early Psoriatic Arthritis J Rheumatol Suppl, August 1, 2009; 83(0): 26 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. CANTINI, L. NICCOLI, C. NANNINI, E. CASSARA, P. PASQUETTI, I. OLIVIERI, and C. SALVARANI Criteria, Frequency, and Duration of Clinical Remission in Psoriatic Arthritis Patients with Peripheral Involvement Requiring Second-line Drugs J Rheumatol Suppl, August 1, 2009; 83(0): 78 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Eroschenko, K. W. Cleveland, and K. Gunter Psoriatic Arthritis: A Review Journal of Pharmacy Practice, February 1, 2009; 22(1): 86 - 103. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Cantini, L. Niccoli, C. Nannini, E. Cassara, P. Pasquetti, I. Olivieri, and C. Salvarani Frequency and duration of clinical remission in patients with peripheral psoriatic arthritis requiring second-line drugs Rheumatology, June 1, 2008; 47(6): 872 - 876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Taylor and P. S. Helliwell Psoriatic arthritis is a joint-damaging disease a call for action! Rheumatology, December 1, 2007; 46(12): 1747 - 1748. [Full Text] [PDF]
|
|
|
|
|
|
C. Morgan, M. Lunt, D. Bunn, D. G. I. Scott, and D. P. M. Symmons Five-year outcome of a primary-care-based inception cohort of patients with inflammatory polyarthritis plus psoriasis Rheumatology, December 1, 2007; 46(12): 1819 - 1823. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Bravo Vergel, N. S. Hawkins, K. Claxton, C. Asseburg, S. Palmer, N. Woolacott, I. N. Bruce, and M. J. Sculpher The cost-effectiveness of etanercept and infliximab for the treatment of patients with psoriatic arthritis Rheumatology, November 1, 2007; 46(11): 1729 - 1735. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J Bond, V. T Farewell, C. T Schentag, and D. D Gladman Predictors for radiological damage in psoriatic arthritis: results from a single centre Ann Rheum Dis, March 1, 2007; 66(3): 370 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A W R van Kuijk, P Reinders-Blankert, T J M Smeets, B A C Dijkmans, and P P Tak Detailed analysis of the cell infiltrate and the expression of mediators of synovial inflammation and joint destruction in the synovium of patients with psoriatic arthritis: implications for treatment Ann Rheum Dis, December 1, 2006; 65(12): 1551 - 1557. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Kavanaugh, C E Antoni, D Gladman, S Wassenberg, B Zhou, A Beutler, G Keenan, G Burmester, D E Furst, M H Weisman, et al. The Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT): results of radiographic analyses after 1 year Ann Rheum Dis, August 1, 2006; 65(8): 1038 - 1043. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Siannis, V T Farewell, R J Cook, C T Schentag, and D D Gladman Clinical and radiological damage in psoriatic arthritis Ann Rheum Dis, April 1, 2006; 65(4): 478 - 481. [Abstract] [Full Text] [PDF]
|
|