TY - JOUR
T1 - Early psoriatic arthritis
T2 - The clinical spectrum
AU - Scarpa, Raffaele
AU - Cuocolo, Alberto
AU - Peluso, Rosario
AU - Atteno, Mariangela
AU - Gisonni, Pietro
AU - Iervolino, Salvatore
AU - Di Minno, Matteo Nicola Dario
AU - Nicolai, Emanuele
AU - Salvatore, Marco
AU - Del Puente, Antonio
PY - 2008/1
Y1 - 2008/1
N2 - Objective. To characterize the clinical pattern of early psoriatic arthritis (PsA). Methods. We studied 47 consecutive patients: 29 had definite PsA and 18 had the "sine psoriasis" subset. Inclusion criteria were articular and/or entheseal involvement of ≤ 12 weeks' duration and the exclusive use, before enrollment, of nonsteroidal antiinflammatory drugs to control articular symptoms. All patients underwent clinical examination, blood tests, total-body bone scintigraphy, articular ultrasonography, and radiography of clinically involved joints and/or entheses. Results. On the basis of clinical examination, early PsA was an oligo-enthesoarthritis in over 75% of patients studied. In contrast, the number of joints and/or entheses showing increased tracer uptake on bone scintigraphy was 3 times greater, compared to the clinical evidence (p <0.001). Articular ultrasonography confirmed the inflammatory involvement of synovium and/or entheses in all articular sites active at time of bone scintigraphy, but silent at clinical examination. In addition, 7 patients showed the occurrence of joint and/or entheseal erosions on standard radiography. Conclusion. Bone scintigraphy yields a more accurate evaluation of entheso-articular involvement and distribution in patients with early PsA. Our results suggest that clinical oligo-enthesoarthritic presentation of early PsA might represent in most cases a polyarticular condition that is at increased risk for clinical progression. These findings have a significant influence on the clinical decision-making process in patients with early PsA.
AB - Objective. To characterize the clinical pattern of early psoriatic arthritis (PsA). Methods. We studied 47 consecutive patients: 29 had definite PsA and 18 had the "sine psoriasis" subset. Inclusion criteria were articular and/or entheseal involvement of ≤ 12 weeks' duration and the exclusive use, before enrollment, of nonsteroidal antiinflammatory drugs to control articular symptoms. All patients underwent clinical examination, blood tests, total-body bone scintigraphy, articular ultrasonography, and radiography of clinically involved joints and/or entheses. Results. On the basis of clinical examination, early PsA was an oligo-enthesoarthritis in over 75% of patients studied. In contrast, the number of joints and/or entheses showing increased tracer uptake on bone scintigraphy was 3 times greater, compared to the clinical evidence (p <0.001). Articular ultrasonography confirmed the inflammatory involvement of synovium and/or entheses in all articular sites active at time of bone scintigraphy, but silent at clinical examination. In addition, 7 patients showed the occurrence of joint and/or entheseal erosions on standard radiography. Conclusion. Bone scintigraphy yields a more accurate evaluation of entheso-articular involvement and distribution in patients with early PsA. Our results suggest that clinical oligo-enthesoarthritic presentation of early PsA might represent in most cases a polyarticular condition that is at increased risk for clinical progression. These findings have a significant influence on the clinical decision-making process in patients with early PsA.
KW - Bone scintigraphy
KW - Clinical involvement
KW - Diagnostic imaging
KW - Psoriasis
KW - Psoriatic arthritis
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M3 - Article
C2 - 18050372
AN - SCOPUS:38149061978
VL - 35
SP - 137
EP - 141
JO - Journal of Rheumatology
JF - Journal of Rheumatology
SN - 0315-162X
IS - 1
ER -