Clinical and radiological damage in psoriatic arthritis

• Published in: Annals of the rheumatic diseases Vol. 65; no. 4; pp. 478 - 481
• Main Authors: Siannis, F, Farewell, V T, Cook, R J, Schentag, C T, Gladman, D D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.04.2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - diagnostic imaging; Arthritis, Psoriatic - drug therapy; Arthritis, Psoriatic - pathology; Biological and medical sciences; Dermatology; Disease Progression; Diseases of the osteoarticular system; Epidemiologic Methods; Extended Report; Fibromyalgia; Hand Joints - diagnostic imaging; Hand Joints - pathology; Humans; Inflammation; Inflammatory joint diseases; joint damage; Medical sciences; Middle Aged; Pharmaceutical industry; Physicians; prognosis; Psoriasis; Psoriasis. Parapsoriasis. Lichen; psoriatic arthritis; Radiography; radiological damage; Severity of Illness Index; Soil erosion; Studies; Time Factors; Spondylarthropathy; Skin disease; Chronic; Psoriasis; Diseases of the osteoarticular system; Rheumatology; Inflammatory joint disease; Psoriatic arthritis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2005.039826

Background: Psoriatic arthritis may progress to joint damage. Joint damage may be assessed clinically, by identifying deformed, fused, or flail joints, or radiologically, by recording erosions, joint space narrowing, ankylosis, lysis, or surgery. The relation between clinical and radiological damage is unclear. Objective: To study the ordering of clinical and radiological damage detection, and the clinical features associated with the type of damage detected first. Methods: The University of Toronto psoriatic arthritis database was used to relate clinical and radiological damage in the hand joints in 655 patients followed prospectively between 1978 and 2003. Generalised estimating equations were used to fit logistic regression models to identify factors that predict classification of damage by radiographic assessment first. Results: The majority of the joints were not informative, as they either had evidence of damage by both methods at entry, or remained undamaged. Of the remainder, 81% of the joints showed radiological damage first and 19% had clinical damage first. Development of radiological damage first was related to previous detection of swollen joints, and was inversely related to duration of arthritis. Conclusions: Radiological damage is often detected before clinical damage is observed. Clinical inflammation often precedes the detection of radiological damage.