Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review

2015 ◽  
Vol 42 (8) ◽  
pp. 1432-1438 ◽  
Author(s):  
Amir Haddad ◽  
Sindhu R. Johnson ◽  
Mansour Somaily ◽  
Rouhi Fazelzad ◽  
Amie T. Kron ◽  
...  
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Severe Form ◽  
Classification Criteria ◽  
Language Restriction ◽  
Axial Disease ◽  
Joint Erosions ◽  
Definition Of ◽  
Metatarsophalangeal Joints ◽  
Arthritis Mutilans

Objective.Research on psoriatic arthritis mutilans (PAM), the most severe form of psoriatic arthritis, is impeded by the lack of an accepted classification criteria. We performed a systematic review of the literature to identify and synthesize clinical and radiographic features associated with the definition of PAM.Methods.A systematic literature search limited to human studies was conducted without language restriction. Abstracts were independently screened by 2 investigators and studies that reported information on patients with PAM were included. A standardized form was used to independently collect clinical and radiographic items defining PAM, patient’s demographics, disease characteristics, and outcomes.Results.There were 8570 citations searched to identify 112 articles for full review and 58 articles for data abstraction. We identified 8 definitions of PAM that were used in 283 subjects with a mean age ± SD at diagnosis of PsA of 33.9 ± 8.2 years. Disease manifestations (prevalence) included dactylitis (29–64%), enthesitis (29–32%), axial disease (14–27%), and nail lesions (47%). PAM definitions include 1 (n = 2 studies) or more (n = 14 studies) joints involving interphalangeal, metacarpophalangeal, or metatarsophalangeal joints. The most prevalent PAM clinical features were digital telescoping (34%), digital shortening (33%), and flail joints (22%). The most prevalent PAM radiographic items were bone resorption (41%), pencil-in-cup change (16%), total joint erosions (14%), ankylosis (21%), and subluxation (7%).Conclusion.We have identified 8 definitions of PAM, and synthesized the clinical and radiographic items that are important for the classification of PAM. We have established the groundwork for future development classification criteria for PAM.

Arthritis Mutilans: A Report from the GRAPPA 2012 Annual Meeting

2013 ◽  
Vol 40 (8) ◽  
pp. 1419-1422 ◽  
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.

HELIOTHERAPY IN THE TREATMENT OF PSORIATIC ARTHRITIS

2018 ◽  
Vol 28 (2) ◽  
pp. 483-487
Author(s):  
Snezhina Georgieva ◽  
Dilyana Zvezdova
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Picture ◽  
Local Therapy ◽  
Severe Form ◽  
Climatic Conditions ◽  
Joint Disease ◽  
Immune Mediated ◽  
Social Comfort ◽  
Pigment Type ◽  
Definition Of

Psoriatic arthritis is an inflammatory joint disease associated with psoriasis vulgaris, with routinely negative rheumatoid factors and the absence of rheumatoid nodules. This is an immune-mediated disease, according to generally accepted definition of Wright and Moll from 1973. American Association against Rheumatism classified psoriatic arthritis as an independent disease in 1964. Psoriatic arthritis is a single disease with a varied clinical picture. It belongs to the group of seronegative spondyloarthropathies with which there are general clinical features. It is believed that similar mechanisms determine the onset of psoriasis and psoriatic arthritis. The clinical picture includes various clinical forms that damage the peripheral and sacroiliac joints, spine, internal organs. The treatment of psoriatic arthritis is directed simultaneously to the influence of skin and joint changes. Purpose: Our study aims to summarize our long-standing experience in the treatment of psoriatic arthritis with heliotherapy. Subject of observation: Monitoring includes 132 patients with moderate and severe form of psoriasis treated at the sanatorium in town of Pomorie for 5 years in the period 2001-2006. Results and discussion: 132 patients with psoriasis with no effect on the local therapy and have proven psoriatic arthritis were selected. In our climatic conditions, heliotherapy is appointed during the warm half-year. Sun treatment was conducted under the conditions of a healing beach, which had shielding, radiation-protective devices. In patients with erythema - pigment and pigment type skin reactivity begins with 1-2 bioadoses reached to 8-10 biodoses, carried out in the area of overcomfort. Conclusion: The studies demonstrated that heliotherapy combined with medications significantly improves the prognosis of patients with this disease. The ultimate success would mean overcoming the frequent depression conditions, better survival and social comfort for patients with psoriatic arthritis.

scholarly journals Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis

2016 ◽  
Vol 76 (4) ◽  
pp. 701-707 ◽  
Author(s):  
Deepak R Jadon ◽  
Raj Sengupta ◽  
Alison Nightingale ◽  
Mark Lindsay ◽  
Eleanor Korendowych ◽  
...  
Keyword(s):  
New York ◽  
Psoriatic Arthritis ◽  
Significant Proportion ◽  
Classification Criteria ◽  
Single Centre ◽  
Cross Sectional ◽  
Incidence Risk ◽  
Axial Disease ◽  
Multivariable Analyses ◽  
Adjusted Incidence

ObjectivesTo compare the prevalence, clinical and radiographic characteristics of psoriatic spondyloarthritis (PsSpA) in psoriatic arthritis (PsA), with ankylosing spondylitis (AS).MethodsA prospective single-centre cross-sectional observational study recruited consecutive PsA and AS cases. Participants completed outcome measures, and underwent clinical examination, axial radiographic scoring and HLA-sequencing. Multivariable analyses are presented.ResultsThe 402 enrolled cases (201 PsA, 201 AS; fulfilling classification criteria for respective conditions) were reclassified based upon radiographic axial disease and psoriasis, as: 118 PsSpA, 127 peripheral-only PsA (pPsA), and 157 AS without psoriasis (AS) cases. A significant proportion of patients with radiographic axial disease had PsSpA (118/275; 42.91%), and often had symptomatically silent axial disease (30/118; 25.42%). Modified New York criteria for AS were fulfilled by 48/201 (23.88%) PsA cases, and Classification of Psoriatic Arthritis criteria by 49/201 (24.38%) AS cases. pPsA compared with PsSpA cases had a lower frequency of HLA-B*27 (OR 0.12; 95% CI 0.05 to 0.25). Disease activity, metrology and disability were comparable in PsSpA and AS. A significant proportion of PsSpA cases had spondylitis without sacroiliitis (39/118; 33.05%); they less frequently carried HLA-B*27 (OR 0.11; 95% CI 0.04 to 0.33). Sacroiliac joint complete ankylosis (adjusted OR, ORadj 2.96; 95% CI 1.42 to 6.15) and bridging syndesmophytes (ORadj 2.78; 95% CI 1.49 to 5.18) were more likely in AS than PsSpA. Radiographic axial disease was more severe in AS than PsSpA (Psoriatic Arthritis Spondylitis Radiology Index Score: adjusted incidence risk ratio 1.13; 95% CI 1.09 to 1.19).ConclusionsIn a combined cohort of patients with either PsA or AS from a single centre, 24% fulfilled classification criteria for both conditions. The pattern of axial disease was influenced significantly by the presence of skin psoriasis and HLA-B*27.

scholarly journals Targeted Therapies in Axial Psoriatic Arthritis

2021 ◽  
Vol 12 ◽  
Author(s):  
Alberto Floris ◽  
Mattia Congia ◽  
Elisabetta Chessa ◽  
Maria Maddalena Angioni ◽  
Matteo Piga ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Outcome Measures ◽  
Targeted Therapies ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Specific Outcome ◽  
Axial Disease ◽  
Definition Of ◽  
Almost All ◽  
Post Hoc

Specific and high-quality evidence on the efficacy of the current targeted therapies for axial disease in psoriatic arthritis (axPsA) is still scarce. Indeed, almost all the cohorts investigated in clinical trials on PsA consisted of patients with peripheral arthritis, where a small number of them also had axial involvement. Only one randomized controlled trial was so far specifically designed to assess the efficacy of a biological disease-modifying antirheumatic drug (DMARD) in axPsA. For other biological and synthetic targeted DMARDs, the most specific evidence for treatment in axPsA is extrapolated from post-hoc analyses based on PsA patients with concomitant peripheral and axial manifestations. Furthermore, the current trials and post-hoc analysis on axPsA are affected by major limitations, including the lack of a widely accepted definition of axPsA and the lack of specific and validated outcome measures. Finally, poor data are available on the genetics of axPsA, although alleles differentially expressed in different patterns of axPsA might offer advantages in the prospective of personalized medicine in axPsA patients. Overall, this review suggests that there is an urgent need for more reliable evidence derived from studies specifically designed for axPsA and based on a validated definition of axPsA and on specific outcome measures.

GRAPPA 2013 Annual Meeting, Rheumatology Updates: Psoriatic Arthritis (PsA) Biomarker Project, Arthritis Mutilans, PsA-Peripheral Spondyloarthritis Epidemiology Project

2014 ◽  
Vol 41 (6) ◽  
pp. 1244-1248 ◽  
Author(s):  
Oliver FitzGerald ◽  
Philip J. Mease ◽  
Philip S. Helliwell ◽  
Vinod Chandran
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Joint Damage ◽  
Classification Criteria ◽  
Undifferentiated Arthritis ◽  
Psoriatic Disease ◽  
Inflammatory Bowel ◽  
Peripheral Spondyloarthritis ◽  
Arthritis Mutilans ◽  
Made In

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.

Peripheral arthritis

2018 ◽  
Author(s):  
Raffaele Scarpa ◽  
Francesco Caso ◽  
Luisa Costa ◽  
Rosario Peluso ◽  
Nicola Matteo Dario Di Minno ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Laboratory Tests ◽  
Clinical Presentation ◽  
Psoriatic Skin ◽  
Peripheral Arthritis ◽  
Diagnostic Challenge ◽  
Inappropriate Use ◽  
Distal Interphalangeal ◽  
Metatarsophalangeal Joints ◽  
Arthritis Mutilans

Clinical presentation of peripheral arthritis in patients with psoriatic arthritis (PsA), has been described by Moll and Wright who classified it into four subsets: symmetrical polyarthritis, asymmetrical oligoarthritis, distal interphalangeal (DIP) arthritis and arthritis mutilans. In the symmetrical polyarthritis subset, the distribution of articular involvement is similar to rheumatoid arthritis and this has for many years justified the inappropriate use of the terminology ‘rheumatoid-like form’, at present completely abandoned. Oligoarthritis is characterized by asymmetrical involvement of few joints (less than four), which include scattered DIP or proximal interphalangeal (PIP) joints and/or metatarsophalangeal joints. DIP arthritis may occur with symmetrical or asymmetrical features, and it is often in strict association with onycopathy. The arthritis mutilans pattern is characterized by osteolysis of phalanx and metacarpals and it is very rare, occurring in less than 1% of patients with established form of arthritis. In 15-20% of the cases the arthritis may precede the onset of the psoriatic skin rash. Consequently, psoriatic arthritis ‘sine psoriasis’ should not be considered a rare clinical finding. In this subset articular involvement is clinically expressed, while cutaneous is apparently absent. Laboratory tests and imaging are relevant for differential diagnosis which in some presentations may represent a diagnostic challenge. The outcome of peripheral patterns of PsA patients is related not only to the spectrum of peripheral phenotypes, but also to early diagnosis, and metabolic aspects, which may affect excess in morbidity and mortality.

scholarly journals AB0677 REVISING THE DEFINITION OF REACTIVE ARTHRITIS AND DIFFERENTIATION FROM UNDIFFERENTIATED SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1633.2-1634
Author(s):  
F. Cosan ◽  
O. M. Gedar
Keyword(s):  
Causative Agent ◽  
Reactive Arthritis ◽  
Case Reports ◽  
Experimental Studies ◽  
Classification Criteria ◽  
General Definition ◽  
Parasitic Infections ◽  
Undifferentiated Spondyloarthritis ◽  
Classical Definition ◽  
Definition Of

Background:Reactive arthritis (ReA) is defined by 1999 ACR criteria as arthritis preceding a bacterial genitourinary (GUS) or gastrointestinal (GIS) infection in 3 days-6 weeks and evidence of triggering infection. Recently, ReA is classified as SpA and patients who do not fulfill SpA criteria are classified as undifferentiated spondyloarthritis (USpA) according to ASAS/EULAR SpA classification criteria.Objectives:In several case reports which are associated with other infective agents are reported and the definition is extended for some clinicians so that SpA which is occurred after any infection is called as ReA. On the other hand, some researchers still accept the classical definition of ReA. The problem with the heterogeneity of opinions and unstandardized definition of ReA hinders studies about pathogenesis and standardization of treatments. In this study, we aimed to determine the spectrum of the use of the definition of reactive arthritis in publications in PubMed between 2009-2019.Methods:The ReA keyword is searched in PubMed for the years between 2009-2019. 248 different publications have been identified and included in this research. 89 articles, 47 reviews, 108 case reports, 2 guidelines, and 2 editorials reviewed for the definition of ReA.Results:Only 42.7% (106 patients) of these publications meet the classical definition which suggests ReA after only GIS and GUS infections. In 4 (1.6%) of the publications ReA was defined after GIS, GUS and oropharyngeal infections; in 3 (1,2%) of the publications after any bacterial infection; in 9 (3.6%) of the publications after any infection. In 8 (3.2%) of the publications, ReA and USPA was used correspondingly. In 39 (15,7%) of the publications the term agent related, ReA was used without making a general definition for ReA. 79 publications (31,9%) have not defined ReA.According to causative agent and ReA relationship, in 64 (24,6%) general infective agents, in 75 (30,2%) classical agents, in 22 (8,9%) other bacterial agents, in 23 (9,3%) streptococcus, in 10(4%) intravesical BCG, in 6 (2.4%) HIV, in 6 (2.4%) tuberculosis, in 12 (4,8%) clostrudium difficle, in 2 (0.8%) parasites were reported. In 31 (12,5%) of the publications the causative agent for the ReA was unknown, the diagnosis was made clinically.Conclusion:In this study, it is aimed to draw attention terminology intricacy and the need for the standardization of the definition of ReA and USpA. It is clear that to standardize the definition of Rea and USpA is necessary. Between 2009-2019 there are reported cases diagnosed as ReA associated with bacterial infections (especially with Clostridium difficile, streptococcus and tuberculosis infections), and viral infections (by a majority with HIV), and parasitic infections. It is not clear if we need to define them classically or define them as USPA. Another important consideration is the necessity of extended laboratory investigations to find out the real causative agent even if the patient is clinically diagnosed with ReA. The requirement of the differentiation between ReA and USpA must be revealed for therapeutic researches.References:[1]A proposal for the classification of patients for clinical and experimental studies on reactive arthritis. Pacheco-Tena C, Burgos-Vargas R, Vázquez-Mellado J, Cazarín J, Pérez-Díaz JA. J Rheumatol. 1999 Jun;26(6):1338-46.[2]The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, et al. Ann Rheum Dis. 2011;70:25–31.Disclosure of Interests:None declared

scholarly journals Biomarkers predictive of treatment response in psoriasis and psoriatic arthritis: a systematic review

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110140
Author(s):  
Conor Magee ◽  
Hannah Jethwa ◽  
Oliver M. FitzGerald ◽  
Deepak R. Jadon
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Treatment Response ◽  
Unmet Need ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Original Research ◽  
Eligibility Criteria ◽  
Psoriatic Disease ◽  
Subsequent Response

Aims: The ability to predict response to treatment remains a key unmet need in psoriatic disease. We conducted a systematic review of studies relating to biomarkers associated with response to treatment in either psoriasis vulgaris (PsV) or psoriatic arthritis (PsA). Methods: A search was conducted in PubMed, Embase and the Cochrane library from their inception to 2 September 2020, and conference proceedings from four major rheumatology conferences. Original research articles studying pre-treatment biomarker levels associated with subsequent response to pharmacologic treatment in either PsV or PsA were included. Results: A total of 765 articles were retrieved and after review, 44 articles (22 relating to PsV and 22 to PsA) met the systematic review’s eligibility criteria. One study examined the response to methotrexate, one the response to tofacitinib and all the other studies to biologic disease-modifying antirheumatic drugs (DMARDs). Whilst several studies examined the HLA-C*06 allele in PsV, the results were conflicting. Interleukin (IL)-12 serum levels and polymorphisms in the IL-12B gene show promise as biomarkers of treatment response in PsV. Most, but not all, studies found that higher baseline levels of C-reactive protein (CRP) were associated with a better clinical response to treatment in patients with PsA. Conclusion: Several studies have identified biomarkers associated with subsequent response to treatment in psoriatic disease. However, due to the different types of biomarkers, treatments and outcome measures used, firm conclusions cannot be drawn. Further validation is needed before any of these biomarkers translate to clinical practice.

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