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Patients with psoriatic arthritis mutilans have higher burden of disease
Patients with psoriatic arthritis mutilans had much higher disease burden compared with patients with psoriatic arthritis alone, according to recently published research.
Researchers retrospectively screened 610 patients with psoriatic arthritis (PsA) who met the Classification for Psoriatic Arthritis (CASPAR) criteria for the presence or absence of PsA mutilans (PAM). Radiographic imaging allowed the researchers to identify PAM in 36 of the patients, and inter-rater reliability of scoring was high.
The proportion of women in the PAM group was similar to the group with PsA only, and age of onset was similar between groups, as well; however, patients with PAM tended to be younger (median 33 years vs. 40 years). The distribution of psoriatic nail dystrophy was higher in the group with PAM (odds ratio [OR] = 5.43) and physical function was more impaired compared with the group with PsA. Clinically significant differences were seen in subdomains of the Health Assessment Questionnaire (HAQ), including HAQ-reach (risk ratio [RR] = 1.34) and activity domain (RR = 1.5).
In patients with available anti-citrullinated protein antibodies (ACPA) data, no differences were observed between the two groups, but patients with PAM were more likely to present radiographic axial disease (adjusted OR = 2.31), sacroiliitis (OR = 2.99) and spondylitis (OR = 1.46). In the presence of sacroiliitis in patients with PAM, it was more likely to be bilateral and grade 3 or higher. In the presence of spondylitis in patients with PAM, the effects were seen in both the cervical and lumbar spine.
Patients with PAM were more likely to have received a disease-modifying anti-rheumatic drug (DMARD), including methotrexate, sulfasalazine or leflunomide, and 29 of 33 (87.88%) received a DMARD prior to the radiographic presence of PAM. Similar use of anti-tumor necrosis factor alpha (anti-TNF) treatments were seen between groups, with four of 13 patients with PAM reporting prior use of anti-TNF agents prior to PAM onset, according to the researchers.
Twelve of 35 patients with PAM had concurrent joint osteolysis and ankyloses in the same hand or foot, and two had surgery to correct impaired hand function. Over time, different joints showed different patterns of deterioration, the researchers reported. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.