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Clinical and Radiological Changes During Psoriatic Arthritis Disease Progression
MUSTAFA KHAN, CATHERINE SCHENTAG, and DAFNA D. GLADMAN
ABSTRACT.
Methods. Patients with PsA were followed prospectively at 6–12 month intervals since 1978; 86 patients were registered within 1 year of diagnosis and were followed for at least 1 year. Based on the clinical information, including the actively inflamed joint count, damaged joint count, and the presence of back disease and arthritis mutilans, a clinical PsA pattern was assigned. A separate radiology pattern based on radiographs alone, and a combined clinical and radiological pattern, was also assigned at each visit. The initial clinical pattern was compared to the initial combined clinical-radiological pattern, and the initial clinical pattern was compared to the clinical pattern at 1 year and 5 years in 35 patients with both 1 and 5 year followup. Results. In 23% of the patients, the radiological assessment in the initial visit showed evidence of patterns not detected clinically; 49% and 77% of the patients showed clinical pattern change within 1 year and 5 years, respectively. A comparison between the group that changed pattern and the one that did not change pattern in 5 years revealed no significant features. Conclusion. Radiological assessments add information not gained from clinical assessment alone. Clinical patterns do change over time in the majority of patients. Both elements must be taken into consideration when developing classification criteria for PsA. (J Rheumatol 2003;30:1022-6) Key Indexing Terms:
PSORIATIC ARTHRITIS
From the University of Toronto Psoriatic Arthritis Clinic, Centre for Prognosis in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada. Supported by grants from The Arthritis Society and the Canadian Institutes for Health Research. M. Khan was supported by a CIHR Burroughs Wellcome Fund Student Research Award. M. Khan, Medical Student, University of Toronto; C. Schentag, BSc, Research Associate, Psoriatic Arthritis Program; D.D. Gladman, MD, FRCPC, Professor of Medicine, Director, Psoriatic Arthritis Program, Deputy Director, Centre For Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital. Address reprint requests to Dr. D. Gladman, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, EC-5-0348 399 Bathurst Street, Toronto, Ontario M5T 2S8. E-mail: dafna.gladman@utoronto.ca Submitted April 23, 2002; revision accepted November 8, 2002. |