personal edition > arthrite (autre) > nouvelles


  Envoyez ce DGReview à un collègue par courriel

DGReview

Radiological Joint Damage Occurs Early, Progresses in Psoriatic Arthritis Patients

Psoriatic arthritis (PsA) is a chronic, progressive disease at an early stage and is associated with a higher rate of radiological joint damage than has been previously reported, according to a new study.

Although PsA was initially considered a mild, non-progressive disease compared with rheumatoid arthritis, accumulating evidence confirms that a large number of patients with PsA have persistent inflammation, develop progressive joint damage and disability, and have reduced life expectancy.

To determine the clinical presentation, natural history and prognosis of early PsA, David Kane MB, MRCPI, of the Glasgow Royal Infirmary, Scotland, and colleagues examined a cohort of 129 patients with PsA at an early inflammatory arthritis clinic.

Patients received standardised clinical, laboratory, and radiological assessment at presentation, and were classified as having an asymmetrical oligoarthritis, symmetrical polyarthritis, or predominant spondylitis. Additional assessments were performed at 1 and 2 years of follow up.

Presenting clinical features included a mean patient age of approximately 41 years and mean disease duration of approximately 10 months.

Severe functional limitation was observed in 35% of patients (ACR Steinbrocker functional class 3/4), which decreased to 19% at 1 year and 16% at 2 years.

Joint erosion was the most frequent radiological feature of PsA, with erosions observed in 27% of patients at initial assessment and in 47% of patients at 2 years.

Articular disease persisted in the majority of cases, with 26% in remission at 1 year and 21% in remission at 2 years. Spontaneous (DMARD-free) remission occurred in only 11%-12% of the study population.

Overall, sulphasalazine and methotrexate were the most commonly used DMARDs. Interestingly, methotrexate was found most frequently used at 2 years, despite limited clinical evidence of efficacy in treatment of PsA.

"Despite current DMARD strategies in PsA, progressive radiological damage occurred at an early stage of disease," noted the researchers. "Further controlled studies need to identify patients with severe, progressive PsA and evaluate more aggressive therapeutic strategies such as combination DMARD or biological treatment."


Rheumatology (Oxford) 2003 Oct 1;[Epub ahead of print]. "A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience"

Envoyez ce DGReview à un collègue par courriel

Version pour imprimante