Psoriatic arthritis mutilans (PAM) in the Nordic countries: demographics and disease status. The Nordic PAM study

Objective: Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis due to excessive bone erosion causing joint destruction and decreased functional capacity. The aim of this study was to investigate the prevalence of comorbidities among patients with PAM and the association between comorbidities and joint involvement.Methods: A total of 66 patients aged ≥18 years from the Nordic countries with past or present psoriasis along with at least one mutilated joint were included in the present study.Results: The median number of comorbid conditions per patient was 1 [interquartile range (IQR) 0–2] and 16.7% reported three or more comorbidities. The most frequent comorbidity was hypertension (36.4%). The median number of mutilated joints per patient was 3 (IQR 1–8.3; range 1–38).Conclusion: Two thirds of the patients with PAM reported comorbid conditions and the most frequent was hypertension which affected more than a third of the patients. However, this study was unable to detect any association between comorbidities and the severity of PAM.

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Faculty Opinions recommendation of MRI bone oedema scores are higher in the arthritis mutilans form of psoriatic arthritis and correlate with high radiographic scores for joint damage.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1147147.604273 ◽

2009 ◽

Author(s):

Dafna Gladman ◽

Vinod Chandran

Keyword(s):

Psoriatic Arthritis ◽

Joint Damage ◽

Bone Oedema ◽

Arthritis Mutilans

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Radiographic development during three decades in a patient with psoriatic arthritis mutilans

Acta Radiologica Open ◽

10.1177/2058460115588098 ◽

2015 ◽

Vol 4 (7) ◽

pp. 205846011558809 ◽

Cited By ~ 1

Author(s):

Leena Laasonen ◽

Björn Guðbjörnsson ◽

Leif Ejstrup ◽

Lars Iversen ◽

Thomas Ternowitz ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Early Diagnosis ◽

Effective Treatment ◽

Typical Case ◽

Rare Form ◽

Pip Joint ◽

Hands And Feet ◽

Arthritis Mutilans ◽

Ratingen Score

Psoriatic arthritis mutilans (PAM) is the most severe and rare form of psoriatic arthritis (PsA). We describe radiological development in a typical case of PAM covering three decades in order to elucidate the need for early diagnosis of PAM. Radiographs of hands and feet, taken from 1981 to 2010, were evaluated using the Psoriatic Arthritis Ratingen Score (PARS). When PsA was diagnosed, in 1981, gross deformity was observed in the second PIP joint of the left foot. Several pencil-in-cup deformities and gross osteolysis were present in the feet in the first decade of the disease. Over 10 years, many joints had reached maximum scores. During the follow-up, other joints became involved and the disease developed clinically. Reporting early signs suggestive of PAM, e.g. pencil-in cup deformities and gross osteolysis in any joint, should be mandatory and crucial. This would heighten our awareness of PAM, accelerate the diagnosis, and lead to improved effective treatment in order to minimize joint damages resulting in PAM.

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Comparison of Disease Status and outcomes of Patients With Psoriatic Arthritis (PSA) Receiving Adalimumab or Etanercept Monotherapy In the United States (US)

Value in Health ◽

10.1016/j.jval.2015.03.900 ◽

2015 ◽

Vol 18 (3) ◽

pp. A155

Author(s):

S. Narayanan ◽

Y. Lu ◽

R. Hutchings ◽

E. Baynton

Keyword(s):

United States ◽

Psoriatic Arthritis ◽

Disease Status ◽

The United States

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Arthritis Mutilans: A Report from the GRAPPA 2012 Annual Meeting

The Journal of Rheumatology ◽

10.3899/jrheum.130453 ◽

2013 ◽

Vol 40 (8) ◽

pp. 1419-1422 ◽

Cited By ~ 8

Author(s):

Vinod Chandran ◽

Dafna D. Gladman ◽

Philip S. Helliwell ◽

Björn Gudbjörnsson

Keyword(s):

Psoriatic Arthritis ◽

Annual Meeting ◽

Clinical Features ◽

Severe Form ◽

Group Discussions ◽

Epidemiological Research ◽

Breakout Group ◽

Definition Of ◽

Arthritis Mutilans ◽

Broad Consensus

Arthritis mutilans is often described as the most severe form of psoriatic arthritis. However, a widely agreed on definition of the disease has not been developed. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members hoped to agree on a definition of arthritis mutilans and thus facilitate clinical and molecular epidemiological research into the disease. Members discussed the clinical features of arthritis mutilans and definitions used by researchers to date; reviewed data from the ClASsification for Psoriatic ARthritis study, the Nordic psoriatic arthritis mutilans study, and the results of a premeeting survey; and participated in breakout group discussions. Through this exercise, GRAPPA members developed a broad consensus on the features of arthritis mutilans, which will help us develop a GRAPPA-endorsed definition of arthritis mutilans.

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Case of psoriatic arthritis mutilans whose finger dysfunction was successfully ameliorated by surgical intervention during infliximab treatment

The Journal of Dermatology ◽

10.1111/1346-8138.14234 ◽

2018 ◽

Vol 45 (3) ◽

pp. e61-e62

Author(s):

Yuka Kunimi ◽

Monji Koga ◽

Takuya Ishibashi ◽

Yoshitsugu Tanaka ◽

Takuaki Yamamoto ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Surgical Intervention ◽

Infliximab Treatment ◽

Arthritis Mutilans

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Serious infections in patients with rheumatoid arthritis and psoriatic arthritis treated with tumour necrosis factor inhibitors: data from register linkage of the NOR-DMARD study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-221007 ◽

2021 ◽

pp. annrheumdis-2021-221007

Author(s):

Ingrid Egeland Christensen ◽

Siri Lillegraven ◽

Pawel Mielnik ◽

Gunnstein Bakland ◽

Liz Loli ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Cox Regression ◽

Disease Status ◽

Incidence Rates ◽

Serious Infections ◽

Factor Inhibitor ◽

Necrosis Factor

ObjectivesTo estimate the incidence of serious infections (SIs) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) treated with tumour necrosis factor inhibitor (TNFi), and compare risk of SIs between patients with RA and PsA.MethodsWe included patients with RA and PsA from the NORwegian-Disease Modifying Anti-Rheumatic Drug registry starting TNFi treatment. Crude incidence rates (IRs) and IR ratio for SIs were calculated. The risk of SIs in patients with RA and PsA was compared using adjusted Cox-regression models.ResultsA total of 3169 TNFi treatment courses (RA/PsA: 1778/1391) were identified in 2359 patients. Patients with RA were significantly older with more extensive use of co-medication. The crude IRs for SIs were 4.17 (95% CI 3.52 to 4.95) in patients with RA and 2.16 (95% CI 1.66 to 2.81) in patients with PsA. Compared with the patients with RA, patients with PsA had a lower risk of SIs (HR 0.59, 95% CI 0.41 to 0.85, p=0.004) in complete set analysis. The reduced risk in PsA versus RA remained significant after multiple adjustments and consistent across strata based on age, gender and disease status.ConclusionsCompared with patients with RA, the risk of SIs was significantly lower in patients with PsA during TNFi exposure.

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