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Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage

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Abstract

This study aims to identify the clinical predictors of arthritis in patients with psoriasis and to evaluate the use of musculoskeletal ultrasonography (US) as a predictor for inflammatory structural progression in psoriatic patients. Measures of association (odds ratio (OR)) were tested, in a prospective, cohort 1-year follow-up study, between structural deterioration and the presence of baseline inflammation, or its persistence. One hundred twenty-six psoriatic patients were prospectively evaluated both clinically and by US at 0, 6, and 12 months for synovitis/ joint damage, enthesitis, and onychopathy. X-ray was performed at 0 and 12 months. One hundred twelve sex and age-matched pasoriatic patients without histories of musculoskeletal symptoms were included as control group. Structural deterioration was observed in 47 % of the 5,292 evaluated joints. Clinical variables associated with arthritis risk: BMI > 25 (OR = 1.7), body surface area (OR = 1.13), family history (OR = 5.72) and nail involvement (OR = 2.25). BMI > 30 was significantly correlated (P < 0.01) with shorter time for the onset of arthritis. Baseline synovial score/PD score ≥ 2 was associated with increased risk of structural progression: OR = 1.98 versus 2.61 versus 2.66 (P < 0.001) for the clinical versus US-gray scale (GS) versus US-power Doppler (PD) evaluation, respectively. An increased probability for structural progression in the presence of enthesitis was observed (OR = 2.79 and 3.50) for both US-GS and US-PD, whereas OR was 2.46 for clinical examination. Onychopathy was associated with structural joint damage (OR = 2.30). In multivariate logistic regression analysis, persistent of synovitis/enthesitis at 6 months of therapy was predictive of subsequent structural progression. Family history of psoriatic arthritis, large BMI (>25), high percentage of psoriatic body surface area, and nail involvement were significantly associated with early onset psoriatic arthritis. Baseline GS score of ≥2, PD score of ≥2, presence of enthesitis, enhanced vascularity at enthesitis, higher GUESS score, and onychopathy, all at base line as well as persistent synovitis and enthesitis at 6 months are predictors of progressive early psoriatic arthritis. Regular ultrasonographic monitoring of these patients is mandatory to assess the progression of their arthritis status.

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References

  1. McHugh NJ, Balachrishnan C, Jones SM (2003) Progression of peripheral joint disease in psoriatic arthritis: a 5-year prospective study. Rheumatology (Oxford) 42:778–783

    Article  CAS  Google Scholar 

  2. Gladman DD, Stafford-Brady F, Chang CH, Lewandowski K, Russell ML (1990) Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol 17:809–812

    CAS  PubMed  Google Scholar 

  3. Torre Alonso JC, Rodriguez Perez A, Castrillo JM, Ballina Garcia J, Riestra Noriega JL, Lopez Larrea C (1991) Psoriatic arthritis (PA): a clinical and radiological study of 180 patients. Br J Rheumatol 30:245–250

    Article  CAS  PubMed  Google Scholar 

  4. Kane D, Stafford L, Bresnihan B, FitzGerald O (2003) A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford) 42:1460–1468

    Article  CAS  Google Scholar 

  5. Gladman DD, Farewell VT, Wong K, Husted J (1998) Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death. Arthritis Rheum 41:1103–1110

    Article  CAS  PubMed  Google Scholar 

  6. Gladman DD (2005) Disability and quality of life considerations. Psoriatic arthritis. In: Gordon GB, Ruderman E (eds) Psoriasis and psoriatic arthritis: an integrated approach. Springer- Verlag, Heidelberg, pp 118–123

    Chapter  Google Scholar 

  7. Bandinelli F, Prignano F, Bonciani D, Pallanti S, Lotti T, Giovannini L, Maddali Bongi S, Matucci Cerinic M (2013) Clinical and socio-demographic factors influence on anxiety and depression in early psoriatic arthritis (ePsA). Clin Exp Rheumatol 31:0318–0319

    Google Scholar 

  8. Kavanaugh AF, Ritchlin CT (2006) and the GRAPPA Treatment Guideline Committee. Systematic review of treatments for psoriatic arthritis: an evidence based approach and basis for treatment guidelines. J Rheumatol 33:1417–1421

    PubMed  Google Scholar 

  9. Mease PJ, Kivitz AJ, Burch FX et al (2004) Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum 50:2264–2272

    Article  CAS  PubMed  Google Scholar 

  10. Kavanaugh A, Antoni CE, Gladman D et al (2006) The Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT): results of radiographic analyses after 1 year. Ann Rheum Dis 65:1038–1043

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Mease PJ, Gladman DD, Ritchlin CT et al (2005) Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 52:3279–3289

    Article  CAS  PubMed  Google Scholar 

  12. McInnes I, Kavanaugh A, Gottlieb A et al (2013) Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicenter, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 382(9894):780–789

    Article  CAS  PubMed  Google Scholar 

  13. Salvarani C, Olivieri I, Pipitone N et al (2006) Recommendations of the Italian Society for Rheumatology for the use of biologic (TNFalpha blocking) agents in the treatment of psoriatic arthritis. ClinExpRheumatol 24:70–78

    CAS  Google Scholar 

  14. Salvarani C, Cantini F, Olivieri I et al (1997) Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis. J Rheumatol 24:1106–1110

    CAS  PubMed  Google Scholar 

  15. Jones SM, Armas JB, Cohen MG et al (1994) Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol 33:834–839

    Article  CAS  PubMed  Google Scholar 

  16. Gladman DD, Shuckett R, Russell ML et al (1987) Psoriatic arthritis (PSA)—an analysis of 220 patients. Q J Med 62:127–141

    CAS  PubMed  Google Scholar 

  17. McGonagle D, Ash Z, Dickie L, McDermott M, Aydin SZ (2011) The early phase of pasoriatic arthritis. Ann Rheum Dis 70(Suppl 1):i71–i76

    Article  CAS  PubMed  Google Scholar 

  18. Ory PA, Gladman D, Mease P (2005) Psoriatic arthritis and imaging. Ann Rheum Dis 64(2):ii55–ii57

    PubMed Central  PubMed  Google Scholar 

  19. Wiell C et al (2007) Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res Ther 9:R119

    Article  PubMed Central  PubMed  Google Scholar 

  20. Peloso PM, Behl M, Hull P, Reeder B (1997) The psoriasis and arthritis questionnaire (PAQ) in detection of arthritis among patients with psoriasis. Arthritis Rheum 40(Suppl):S64

    Google Scholar 

  21. Gladman DD et al (2009) Development and initial validation of a screening questionnaire for psoriatic arthritis: The Toronto Psoriatic Arthritis Screen (ToPAS). Ann Rheum Dis 68:497–501

    Article  CAS  PubMed  Google Scholar 

  22. El Miedany Y, El Gaafary M, Youssef S, Palmer D (2010) Towards a multidimensional patient reported outcome measures assessment: development and validation of a questionnaire for patients with ankylosing spondylitis/spondyloarthritis. Joint Bone Spine 77(6):575–581

    Article  PubMed  Google Scholar 

  23. Taylor W, Gladman D, Helliwell P et al (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  PubMed  Google Scholar 

  24. Fernández-Espartero C, de Miguel E, Loza E et al. Validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme. Ann Rheum Dis doi:10.1136/annrheumdis-2012-202976

  25. Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A et al (2003) Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 62:127–132

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Sharp JT, Lidsky MD, Collins LC, Moreland J (1971) Method of scoring the progression of radiologic changes in rheumatoid arthritis. Arthritis Rheum 14:706–720

    Article  CAS  PubMed  Google Scholar 

  27. Sharp JT, Young DY, Bluhm GP et al (1985) How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? Arthritis Rheum 28:1326–1335

    Article  CAS  PubMed  Google Scholar 

  28. Bennet PH, Burch TA (1967) New York Symposium of population studies in rheumatic diseases: new diagnostic criteria. Bull Rheum Dis 17:453–458

    Google Scholar 

  29. Moll J, Wright V (1973) New York clinical criteria for ankylosing Spondylitis. A statistical evaluation. Ann Rheum Dis 32:354–363

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Szkudlarek M, Court-Payen A, Strandberb C (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 44:2018–2023

    Article  CAS  PubMed  Google Scholar 

  31. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61:905–910

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. De simone C, Caldarola G, D’Agostino M et al (2011) Usefulness of ultrasound imaging in detecting psoriatic arthritis of fingers and toes in patients with psoriasis. Clin Dev Immunol. doi:10.1155/2011/390726

    PubMed Central  PubMed  Google Scholar 

  33. Bandinelli F, Prignano F, Bonciani D et al (2013) Ultrasound detects occult entheseal involvement in early psoriatic arthritis independently of clinical features and psoriasis severity. Clin Exp Rheumatol 31:0219–0224

    Google Scholar 

  34. Husted JA, Tom BD, Farewell VT (2007) e t al. A longitudinal study of the effect of disease activity and clinical damage on physical function over the course of psoriatic arthritis: does the effect change over time? Arthritis Rheum 56:840–849

    Article  PubMed  Google Scholar 

  35. Gladman DD, Farewell VT, Wong K (1998) e t al. Mortality studies in psoriatic arthritis: results from a single outpatient center. II. Prognostic indicators for death. Arthritis Rheum 41:1103–1110

    Article  CAS  PubMed  Google Scholar 

  36. Gladman D, Thavaneswaran A, Chandran V, Cook R (2011) Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis. doi:10.1136/ard.2011.150938

    PubMed Central  Google Scholar 

  37. Bandinelli F, Bonacci E, Matucci M (2013) Ultrasound-integrated tight control in early psoriatic arthritis (PsA) during Adalimumab treatment. Clin Exp Rheumatol 31:440–442

    PubMed  Google Scholar 

  38. Witt M, Mueller F, Nigg A et al (2013) Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis. Arthritis Rheum 65(7):1694–1701

    Article  PubMed  Google Scholar 

  39. Scott DL, Antoni C, Choy EH, van Riel PC (2003) Joint counts in routine practice [editorial]. Rheumatology (Oxford) 42:919–923

    Article  CAS  Google Scholar 

  40. Van der Heijde DM, van 't Hof M, Van Riel PL, van de Putte LB (1993) Validity of single variables and indices to measure disease activity in rheumatoid arthritis. J Rheumatol 20:538–541

    PubMed  Google Scholar 

  41. Hart LE, Tugwell P, Buchanan WW, Norman GR, Grace EM, Southwell D (1985) Grading of tenderness as a source of interrater error in the Ritchie articular index. J Rheumatol 12:716–717

    CAS  PubMed  Google Scholar 

  42. Grunke M, Antoni CE, Kavanaugh A, Hildebrand V, Dechant C, Schett G (2010) etal. Standardization of joint examination technique leads to a significant decrease in variability among different examiners. J Rheumatol 37:860–864

    Article  PubMed  Google Scholar 

  43. Taylor W et al (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  PubMed  Google Scholar 

  44. Chandran V et al (2009) Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. Arthritis Care Res 57:1560–1563

    Article  Google Scholar 

  45. D'Angelo S et al (2009) Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. J Rheumatol 36:368–370

    Article  PubMed  Google Scholar 

  46. Williamson L, Dalbeth N, Dockerty J et al (2004) Nail disease in psoriatic arthritis—clinically important, potentially treatable and often overlooked. Rheumatology 43:790–794

    Article  CAS  PubMed  Google Scholar 

  47. Wilson FC, Icen M, Crowson CS et al (2009) Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum 61:233–239

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  48. McGonaglea D, Benjaminb M, Lyn TA (2009) The pathogenesis of psoriatic arthritis and associated nail disease: not autoimmune after all? Curr Opin Rheumatol 21:340–347

    Article  Google Scholar 

  49. Tan AL, Benjamin M, Toumi H et al (2007) The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis: a high-resolution MRI and histological study. Rheumatology (Oxford) 46:253–256

    Article  CAS  Google Scholar 

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Acknowledgments

The authors would like to express thanks to all participants, colleagues, research assistants, and nurses for their cooperation and help to bring this research to its final conclusions. The authors have no relevant financial disclosures.

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Authors and Affiliations

  1. Darent Valley Hospital, Dartford, Kent, UK

    Yasser El Miedany

  2. Rheumatology & Rehabilitation Department, Ain Shams University, Cairo, Egypt

    Yasser El Miedany & Sally Youssef

  3. Department of Community, Environmental and Occupational Medicine, Ain Shams University, Cairo, Egypt

    Maha El Gaafary

  4. Internal Medicine Department, Cairo University, Cairo, Egypt

    Ihab Ahmed

  5. Radiology, Ain Shams University, Cairo, Egypt

    Annie Nasr

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  1. Yasser El Miedany
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  2. Maha El Gaafary
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  4. Ihab Ahmed
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  5. Annie Nasr
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Correspondence to Yasser El Miedany.

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El Miedany, Y., El Gaafary, M., Youssef, S. et al. Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage. Clin Rheumatol 34, 307–313 (2015). https://doi.org/10.1007/s10067-014-2630-2

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  • DOI: https://doi.org/10.1007/s10067-014-2630-2

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