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Early Psoriatic Arthritis: The Clinical Spectrum
RAFFAELE SCARPA, ALBERTO CUOCOLO, ROSARIO PELUSO, MARIANGELA ATTENO, PIETRO GISONNI, SALVATORE IERVOLINO, MATTEO NICOLA DARIO Di MINNO, EMANUELE NICOLAI, MARCO SALVATORE, and ANTONIO del PUENTE
ABSTRACT. Methods. We studied 47 consecutive patients: 29 had definite PsA and 18 had the "sine psoriasis" subset. Inclusion criteria were articular and/or entheseal involvement of ≤ 12 weeks' duration and the exclusive use, before enrollment, of nonsteroidal antiinflammatory drugs to control articular symptoms. All patients underwent clinical examination, blood tests, total-body bone scintigraphy, articular ultrasonography, and radiography of clinically involved joints and/or entheses. Results. On the basis of clinical examination, early PsA was an oligo-enthesoarthritis in over 75% of patients studied. In contrast, the number of joints and/or entheses showing increased tracer uptake on bone scintigraphy was 3 times greater, compared to the clinical evidence (p < 0.001). Articular ultrasonography confirmed the inflammatory involvement of synovium and/or entheses in all articular sites active at time of bone scintigraphy, but silent at clinical examination. In addition, 7 patients showed the occurrence of joint and/or entheseal erosions on standard radiography. Conclusion. Bone scintigraphy yields a more accurate evaluation of entheso-articular involvement and distribution in patients with early PsA. Our results suggest that clinical oligo-enthesoarthritic presentation of early PsA might represent in most cases a polyarticular condition that is at increased risk for clinical progression. These findings have a significant influence on the clinical decision-making process in patients with early PsA. (First Release Nov 15 2007; J Rheumatol 2008;35:137-41) Key Indexing Terms:
PSORIASIS
From the Department of Clinical and Experimental Medicine, Early Psoriatic Arthritis Clinic, Rheumatology Research Unit and the Department of Biomorphological and Functional Sciences, University Federico II, Naples, and the SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy. R. Scarpa, MD; R. Peluso, MD; M. Atteno, MD; S. Iervolino, MD; M.N.D. Di Minno, MD; A. del Puente, MD, Department of Clinical and Experimental Medicine, University Federico II; A. Cuocolo, MD; P. Gisonni, MD; M. Salvatore, MD, Department of Biomorphological and Functional Sciences, University Federico II; E. Nicolai, MD, SDN Foundation, Institute of Diagnostic and Nuclear Development. Address reprint requests to Dr. R. Scarpa, Rheumatology Research Unit, University Federico II, via Sergio Pansini 5, 80131 Naples, Italy. E-mail: rscarpa@unina.it Accepted for publication July 27, 2007. |