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.

At the 2013 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), several key GRAPPA projects on musculoskeletal aspects of psoriatic disease were reviewed. In this article, lead investigators summarize the progress made in a multicenter study, the PsA BioDam (Psoriatic Arthritis Biomarkers for Joint Damage), to identify soluble biomarkers for joint damage, as well as developing classification criteria for arthritis mutilans. Also reviewed are concepts and rationale behind a proposal to study classification criteria for peripheral spondyloarthritis, including PsA, reactive arthritis, inflammatory bowel disease-associated arthritis, and undifferentiated arthritis.

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Radiographic scoring systems for psoriatic arthritis are insufficient for psoriatic arthritis mutilans: results from the Nordic PAM Study

Acta Radiologica Open ◽

10.1177/2058460120920797 ◽

2020 ◽

Vol 9 (4) ◽

pp. 205846012092079

Author(s):

Leena Laasonen ◽

Ulla Lindqvist ◽

Lars Iversen ◽

Leif Ejstrup ◽

Thorarinn Jonmundsson ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Joint Destruction ◽

Health Assessment ◽

Joint Damage ◽

Scoring Systems ◽

History Of ◽

The Mean ◽

And Gender ◽

Hands And Feet ◽

Arthritis Mutilans

Background Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis (PsA). Purpose To describe the radiological features in PAM and explore whether existing scoring systems for radiological damage in psoriatic arthritis are applicable for PAM. Material and Methods Radiographs were scored according to the modified Sharp-van der Heijde (mSvdH) and the Psoriatic Arthritis Ratingen Score (PARS) systems for PsA. Results At inclusion, 55 PAM patients (49% women, mean age 58 ± 12 years) had conventional radiographs of both hands and feet. A total of 869 PAM joints were detected and 193 joints with ankylosis. The mean total mSvdH score was 213.7 ± 137.8 (41% of maximum) with a higher score for hands than for feet: 136.6 ± 90.1 vs. 79.1 ± 60.9. However, the total score was relatively higher in the feet than in the hands when compared to the highest possible scoring (47% vs. 38% of max). The mean total PARS score was 126.3 ± 79.6 (35% of max). Scoring for joint destruction was higher than for proliferation (22% vs. 11% of max). Strong correlation was found between mSvdH and PARS (r2 = 0.913). A significant correlation was found between scoring and duration of arthritis and the Health Assessment Questionnaire. History of smoking, BMI, and gender did not influence the scoring values. Conclusions The two scoring systems studied may not be ideal to indicate progression of PAM in advanced disease since they reach ceiling effects rather early. Therefore, reporting early signs suggestive of PAM, e.g. signs of pencil-in-cup deformities or osteolysis, is crucial. This would reveal the presence of PAM and might lead to improved treatment in order to minimize joint damage.

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Delayed Diagnosis of Psoriatic Arthritis Mutilans due to Arthritis Prior to Skin Lesion

Case Reports in Rheumatology ◽

10.1155/2018/4216938 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Takeshi Mochizuki ◽

Katsunori Ikari ◽

Ken Okazaki

Keyword(s):

Psoriatic Arthritis ◽

Skin Lesion ◽

Early Diagnosis ◽

Skin Disease ◽

Inflammatory Arthritis ◽

Delayed Diagnosis ◽

Joint Damage ◽

Psoriatic Skin ◽

Spinal Radiograph ◽

Arthritis Mutilans

Psoriatic arthritis (PsA) is a type of inflammatory arthritis characterized by cutaneous psoriasis, peripheral joint damage, axial joint damage, and enthesitis and is usually diagnosed after the appearance of psoriatic skin disease. PsA mutilans is relatively rare in Japan. In the present case, the patient was diagnosed with PsA with foot mutilans deformity only. Hand and spinal radiograph findings were unremarkable. As in the present case arthritis is occurred prior to the onset of skin lesion, we should make early diagnosis to prevent mutilans deformity.

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Faculty Opinions recommendation of Zoledronic acid does not reduce MRI erosive progression in PsA but may suppress bone oedema: the Zoledronic Acid in Psoriatic Arthritis (ZAPA) Study.

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

10.3410/f.11190956.12173054 ◽

2011 ◽

Author(s):

Johanne Martel-Pelletier ◽

Lukas M Wildi

Keyword(s):

Psoriatic Arthritis ◽

Zoledronic Acid ◽

Erosive Progression ◽

Bone Oedema

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Recent advances in understanding and managing psoriatic arthritis

F1000Research ◽

10.12688/f1000research.9592.1 ◽

2016 ◽

Vol 5 ◽

pp. 2670 ◽

Cited By ~ 15

Author(s):

Dafna D. Gladman

Keyword(s):

Psoriatic Arthritis ◽

Early Diagnosis ◽

Clinical Laboratory ◽

Joint Damage ◽

Screening Tools ◽

Therapeutic Interventions ◽

Joint Disease ◽

New Therapeutic Approaches ◽

Recent Advances ◽

And Function

This article reviews recent advances in psoriatic arthritis (PsA) over the past several years with emphasis on early diagnosis, better understanding of pathogenesis, and new therapeutic approaches. Early diagnosis is important, since people who present late do not fare as well. There are a number of clinical, laboratory, and ultrasound features that can help identify patients destined to develop PsA, and several screening tools have been developed. It is recognized that genetic and epigenetic factors, as well as T cells and cytokines, play a role in the pathogenesis of PsA, and several targets have been identified for therapeutic interventions. New therapies have been developed and tested in PsA and have been found to be highly effective for both skin and joint manifestations of the disease. The expectation is that, in the future, PsA patients will be treated early and more aggressively and that there will not be significant progression of joint damage. Moreover, with effective treatment of the skin and joint disease and management of risk factors for the comorbidities, we can expect to reduce their occurrence and further reduce the excess mortality and reduced quality of life and function in these patients.

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Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-218744 ◽

2021 ◽

pp. annrheumdis-2020-218744

Author(s):

Irina Gessl ◽

Mihaela Popescu ◽

Victoria Schimpl ◽

Gabriela Supp ◽

Thomas Deimel ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Power Doppler ◽

Joint Damage ◽

Joint Space ◽

Early Arthritis ◽

Damage Score ◽

Established Disease ◽

Active Inflammation

ObjectivesTo determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04).ConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.

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EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217159 ◽

2020 ◽

Vol 79 (6) ◽

pp. 700-712 ◽

Cited By ~ 52

Author(s):

Laure Gossec ◽

Xenofon Baraliakos ◽

Andreas Kerschbaumer ◽

Maarten de Wit ◽

Iain McInnes ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Joint Damage ◽

Janus Kinase ◽

Collaborative Management ◽

Sustained Remission ◽

Tnf Inhibitor ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

Eular Recommendations ◽

Disease Modifying

ObjectiveTo update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA).MethodsAccording to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined.ResultsThe updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed.ConclusionThese recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.

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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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The Self-Administered Psoriasis and Arthritis Screening Questionnaire (PASQ): A Sensitive and Specific Tool for the Diagnosis of Early and Established Psoriatic Arthritis

Psoriasis Forum ◽

10.1177/247553031016a00202 ◽

2010 ◽

Vol 16a (2) ◽

pp. 9-16 ◽

Cited By ~ 10

Author(s):

Majed Khraishi ◽

Ian Landells ◽

Gerry Mugford

Keyword(s):

Psoriatic Arthritis ◽

Joint Damage ◽

Screening Questionnaire ◽

Optimal Score ◽

Short Disease Duration ◽

Established Disease ◽

History Of ◽

Optimal Cutoff Point ◽

Disease Analysis ◽

Early Psoriatic Arthritis

Background Psoriatic arthritis is a serious chronic inflammatory arthritis that can lead to significant joint damage and often is associated with comorbidities. Early detection and effective management of psoriatic arthritis may prevent the development of such complications. Most patients develop psoriatic arthritis years after onset of psoriasis, and most patients with psoriasis alone are managed by dermatologists or general practitioners. These clinicians are thus in an excellent position to screen for psoriatic arthritis early in the disease course. Objective The objective of this study was to evaluate the sensitivity and specificity of the Psoriasis and Arthritis Screening Questionnaire (PASQ) in detecting patients with psoriatic arthritis. Methods Two groups of patients were screened: patients with established disease and patients referred for evaluation of possible (i.e., early) psoriatic arthritis. Results In patients with established disease, analysis of the PASQ score yielded an optimal cutoff point of 9 with 86.27% sensitivity and 88.89% specificity. In patients with early disease, the PASQ indicated an optimal score of 7 with 92.86% sensitivity and 75% specificity. Conclusion The PASQ is an effective screening tool in psoriatic arthritis patients with a long history of disease as well as in those with short disease duration.

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