Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
Research ArticleArticle

The Swedish Early Psoriatic Arthritis Registry 5-year Followup: Substantial Radiographic Progression Mainly in Men with High Disease Activity and Development of Dactylitis

Mats Geijer, Ulla Lindqvist, Tomas Husmark, Gerd-Marie Alenius, Per T. Larsson, Annika Teleman and Elke Theander
The Journal of Rheumatology November 2015, 42 (11) 2110-2117; DOI: https://doi.org/10.3899/jrheum.150165
Mats Geijer
From the Skåne University Hospital, Center for Medical Imaging and Physiology, Lund; Department of Rheumatology, Uppsala University, Uppsala; Falu Lasarett, Rheumatology, Falun; Umeå University, Public Health and Clinical Medicine/Rheumatology, Umeå; Karolinska University Hospital, Rheumatology, Stockholm; Spenshult Hospital, Rheumatology, Olofström; Lund University, Rheumatology, Skåne University Hospital, Malmö, Sweden.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: mats.geijer@med.lu.se
Ulla Lindqvist
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tomas Husmark
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gerd-Marie Alenius
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Per T. Larsson
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Annika Teleman
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elke Theander
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters
PreviousNext
Loading

Abstract

Objective. To describe early radiographic findings in patients from the Swedish psoriatic arthritis (SwePsA) registry, progression of destruction, correlations with clinical disease variables, and predictors of destruction.

Methods. Hand and foot radiographs were available for 72 of 197 SwePsA patients followed for 5 years. Clinical data were collected according to the SwePsA protocol.

Results. Disease characteristics and clinical improvement were similar in men and women. Radiographic abnormalities were more pronounced in men. Total Wassenberg radiographic score at baseline was 0 in 45% of men and 51% of women. One man and one woman had a score > 10. At 5 years, total score was 0 in 14% of men and 40% of women (p = 0.018); 17% of men and 7% of women had scores > 10. Mean total scores for men and women had increased. Baseline erythrocyte sedimentation rate was associated with baseline total radiographic score. In men, swollen joint count was positively, and in women tender joint count negatively, correlated to total radiographic score. After 5 years, only male scores, mainly hand scores, significantly correlated with 28-joint Disease Activity Score and Disease Activity Index for Psoriatic Arthritis scores, swollen joint count, and dactylitis. Achieving remission or minimal disease activity after 5 years protected against structural damage, mainly in men.

Conclusion. Radiographic progression in early PsA was generally slow but substantial. Male sex appears to be a risk factor for early radiographic damage while the presence of baseline radiographic damage and dactylitis developing during followup seem to predict further destruction. Hand and foot radiograph scoring cannot be substituted with clinical signs.

Key Indexing Terms:
  • PSORIATIC ARTHRITIS
  • RADIOGRAPHY
  • DESTRUCTION
  • JOINT EROSIONS
  • OUTCOME
  • DISEASE ACTIVITY SCORE

The psoriatic disease complex consists of skin psoriasis, psoriatic arthritis (PsA), and psoriatic nail disease1. This heterogeneous disorder has highly variable patterns of joint and skin disease of varying degrees of severity. In southern Sweden, 18% of patients with psoriasis also have arthritis, and the local prevalence of PsA is 0.34%2. The joint disease spectrum ranges from mild monoarthritis or oligoarthritis to very severe erosive and destructive polyarthritis. Several disease subsets have been defined based on joint involvement3,4. The clinical picture may change spontaneously with time or after treatment with disease-modifying antirheumatic drugs (DMARD)4. The medical profession is increasingly aware of PsA being associated with musculoskeletal morbidity, resulting in reduced health-related quality of life5, as well as an association with an increased prevalence of comorbidities common to psoriasis, such as cardiovascular disease and metabolic syndrome, and premature death. Osteoporosis and an increased risk of severe infection must also be considered6.

The disease burden of PsA was recently estimated to be as significant as or even greater than the burden of a number of other chronic diseases, including other inflammatory arthritic diseases5, where the risk of lymphoma is increased in rheumatoid arthritis (RA) but only slightly increased in PsA7. In PsA, the early detection of inflammatory peripheral or axial joint involvement may be important to reduce inflammation and prevent destruction, deformity, and functional disability in affected joints. Only a few studies have focused on the radiographic appearance of early PsA4,8,9, reporting high rates of destruction in early disease and showing the importance of imaging in the followup of these patients. Haroon, et al10 evaluated the rate of progression of joint damage in a cohort of patients with disease duration of more than 10 years and found that even a delay of 6 months from the onset of symptoms to the first consultation can lead to the development of more joint erosion and worse longterm physical function. The same study found significantly less frequent drug-free remission and more frequent arthritis mutilans among patients presenting more than 1 year after symptom onset. The authors concluded that adverse clinical, radiographic, quality of life, and physical function outcomes occur early in the course of the disease, and that early diagnosis and treatment is vital for improved outcomes10.

The Swedish Early PsA (SwePsA) registry11,12,13 was established in 2000 to enable studies on early PsA in the Swedish population; to evaluate the course of the disease, socioeconomic issues, and workforce participation; to identify markers of disease progression; and to describe treatment patterns and effects in real-life care. Detailed clinical evaluations from the 5-year followup have been13,14,15,16 and will be published elsewhere. The purpose of the current report is to describe the early radiographic findings in patients with PsA included in the SwePsA registry using the Wassenberg17 score to evaluate the progression of structural damage from diagnosis to the 5-year followup, evaluate patients without progression, analyze correlations with clinical disease variables in early PsA, and identify predictors of progressive destructive joint disease.

MATERIALS AND METHODS

In a prospective study approved by the ethics committee at Uppsala University, patients with early PsA were enrolled for longterm followup. The patients were from 6 rheumatology clinics in Sweden, to cover different genetic backgrounds and climates. The population and detailed enrollment process were described previously11,12,13, and patient inclusion and exclusion in the current report was as previously reported13, but with additional exclusions for missing radiographs (Figure 1).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Flow chart of patient enrollment in the Swedish Early Psoriatic Arthritis Registry (SwePsA). PsA: psoriatic arthritis; CASPAR: ClASsification for Psoriatic ARthritis criteria.

According to the SwePsA protocol, hand and foot radiographs were taken for polyarticular disease or when those joints showed signs of inflammation at baseline, and radiography was repeated at followup. Clinical data were collected according to the SwePsA protocol, with disease activity measured by the research team at each center using the Disease Activity Score for 28 joints (DAS28)18 and the Disease Activity Index for Psoriatic Arthritis (DAPSA) score19,20 [calculated as the swollen joint count (SJC) of 66 joints + tender joint count (TJC) of 68 joints + patient global assessment visual analog scale (VAS; in cm) + pain VAS (in cm) + C-reactive protein (CRP; in mg/dl)]. Correlations between the DAS28 and DAPSA score, their component items, function, Psoriasis Area and Severity Index (PASI), radiographic scores, and progression were analyzed.

Digital radiographs were evaluated using a clinical picture archiving and communications system with high-resolution monitors. At 1 center, imaging was performed with an analog film-screen technique until early 2011, after which a digital imaging system was installed. In the other centers, digital imaging was provided by the local radiology departments for most of the study period. Analog films were scored using a conventional light box and magnifying glass when necessary. Some analog films were scanned locally into digital format with a commercially available radiograph film scanner.

Radiographs were scored according to the Wassenberg/Ratingen scoring system for PsA17 by a musculoskeletal radiologist with 23 years’ experience in arthritis imaging and blinded to all clinical variables (Table 1). Images were mostly scored in chronological order; for practical reasons, such as delayed delivery of radiographs for reading, this was not always possible. The availability of complete 5-year hand and foot radiographs was mandatory for inclusion in the current analysis. When baseline radiographs were missing but 2-year radiographs with score 0 were available, baseline radiographic scores were imputed as a score of 0 (i.e., no progression between baseline and 2-year followup).

View this table:
  • View inline
  • View popup
Table 1.

Wassenberg psoriatic arthritis score. In the Wassenberg scoring system, all distal and proximal interphalangeal joints in the hand, metacarpophalangeal joints, the wrist (30 joints), interphalangeal joint 1 in the feet, and metatarsophalangeal joints 2–5 were scored for destructive and proliferative changes typical of PsA. A total of 40 joints are scored, with a possible total score of 0 to 360. The hand score accounts for 75% of the maximum17. From Wassenberg, et al, Z Rheumatol 2001;60:156–66; reproduced with permission from Springer-Verlag Berlin Heidelberg.

Statistical analysis

Descriptive statistics were used to report relevant demographic and clinical features, as well as radiographic findings. Data at inclusion and the 5-year followup were compared using paired t tests. Subgroups of patients were compared by chi-square and t tests. Correlation analysis between measures and variables was performed using the Spearman rank test because of the skewed distribution of the radiographic scores. To analyze predictors of radiographic outcome and progression between baseline and 5-year followup, univariate and multivariate linear regression and logistic regression were performed and the results expressed as β or OR with p values and 95% CI. These variables were used as potential predictors based on earlier results and published data: sex, baseline age, symptom duration before inclusion, disease activity (DAS28 or DAPSA), joint counts, presence of dactylitis, tenosynovitis, or enthesitis, Health Assessment Questionnaire (HAQ), skin and nail psoriasis, and patient-related measures such as pain and global disease assessment. Calculations were performed in the Statistical Package for Social Sciences (SPSS) for Macintosh, version 21.

RESULTS

In 72 patients [29 men (35%) and 43 women (38%)] with PsA fulfilling the ClASsification for Psoriatic ARthritis (CASPAR) criteria21, the mean (SD) age at inclusion was 47.8 (14.7) years (range 21.0–80.4 yrs) for the entire cohort; 46.4 (14.5) years (range 24.3–77.8 yrs) for men, and 48.7 (15.0) years (range 21.0–80.4 yrs) for women (p = 0.52). As a result of the radiography protocol in SwePsA, the majority of patients with available hand and foot radiographs had polyarticular disease. No patients had arthritis mutilans or axial disease only, and 3 men and none of the women had combined axial and peripheral disease (Table 2). Radiographs of both hands and feet were available for 26 patients at baseline and 5 years, for 16 patients at 2 and 5 years, and for 30 patients at all 3 timepoints.

View this table:
  • View inline
  • View popup
Table 2.

Patient and clinical disease characteristics at baseline and at the 5-year follow-up in 72 patients with early psoriatic arthritis.

The median symptom duration at inclusion was 12 months and was only slightly longer in men than in women (p = 0.52). Details about DAS28, DAPSA, HAQ, PASI, joint counts, VAS scales, and other disease-specific information are reported in Table 2. Apart from higher HAQ in women and more frequently detectable skin psoriasis in men, there were no significant differences between men and women at baseline.

Radiographic scores

No correlation was found between age at baseline and the total destruction score at inclusion (p = 0.13) or 5 years (p = 0.20). At baseline, 35 patients (49%, 95% CI 37%–60%) had no PsA-related radiographic changes [score 0; mean score 2.2, SD 3.3, range 0–22; men: n = 13, 45% (95% CI 26%–64%); women: n = 22, 51% (36%–67%); Table 3].

View this table:
  • View inline
  • View popup
Table 3.

Wassenberg score17 at baseline and at the 5-year followup in 72 patients with early psoriatic arthritis. Data are n (SD), except for Score 0, which are n (%). * indicates significant p values.

Only 1 man and 1 woman had scores > 10. For men and women, the mean (SD) total scores at baseline were 3.2 (4.1) and 1.6 (2.5; p = 0.018); erosion scores 1.2 (2.3) and 0.3 (0.88; p = 0.025); and proliferation scores 1.9 (2.4) and 1.3 (2.0; p = 0.23), respectively. Foot scores at baseline were 1.04 (1.8) and 0.28 (0.74; p = 0.016) and hand scores 2.2 (3.2) and 1.3 (2.4; p = 0.16) for men and women, respectively. Thus, men had significantly greater radiographic damage than women. Although the foot scores contributed to 38% of the total score in men and 28% in women, the difference was not significant.

At 5-year visit, the median total score (Table 3) had increased significantly (p < 0.001) to 3 (mean 5.3, SD 8.7, range 0–60). The score was still 0 in only 21 patients [29%; men: n = 4, 14% (95% CI 0–27); women: n = 17, 40% (95% CI 24–55); p = 0.018]. Five men (17%) and 3 women (7%) had scores > 10. The mean total score was significantly higher in men than in women [8.0 (SD 12.0) vs 3.4 (SD 4.8), p = 0.027]. The mean (SD) erosion scores were 3.4 (8.2) and 0.86 (1.7; p = 0.051) and proliferation scores 4.6 (4.9) and 2.6 (3.5; p = 0.045) for men and women, respectively, at 5-year followup. Foot scores at 5-year followup were 2.5 (3.9) and 0.84 (2.1; p = 0.028) and hand scores 5.6 (8.5) and 2.6 (3.7; p = 0.047) in men and women, respectively. In men the foot scores contributed to 32% of the total score and in women 25%, but the difference was not significant.

Baseline and 5-year scores were highly correlated (for total scores: Spearman ρ 0.752, p < 0.001).

Correlations between baseline radiographic scores and clinical features

At baseline the total Wassenberg score correlated with erythrocyte sedimentation rate (ESR; ρ 0.27, p = 0.027). The SJC was significantly associated with total score (ρ 0.395, p = 0.034) and total hand score (ρ 0.425, p = 0.022) in men, but not in women. In contrast, the TJC was inversely associated with total score (ρ −0.330, p = 0.031) in women, but not in men. Current smokers did not present with higher scores than nonsmokers (2.2 vs 2.2, p > 0.05). Polyarticular disease at baseline was not associated with higher radiographic scores at baseline (2.5 vs 2.0, p > 0.05). Detectable skin psoriasis and nail psoriasis was associated with numerically, but not significantly, higher scores (2.4 vs 1.9 and 2.8 vs 2.0). Presenting with tenosynovitis (n = 18) was associated with significantly higher radiographic scores [3.8 (SD 4.7) vs 1.7 (SD 2.6), p = 0.021], which was also true in women [3.1 (SD 3.9)] with tenosynovitis vs 1.1 (SD 1.8) without tenosynovitis (p = 0.026) but not men [4.6 (SD 5.7) vs 2.7 (SD 3.3), p = 0.26]. In contrast, the presence of enthesitis, especially in the hip and heel region, was associated with lower radiographic scores at baseline [0.87 (SD 1.8) with peripheral enthesitis vs 2.8 (SD 3.7) without peripheral enthesitis, p = 0.024]. The significant association was not present when evaluating men and women separately. Dactylitis was present in 21 (30%) of the patients at baseline but was not associated with higher radiographic scores at this timepoint.

After 5 years total radiographic score and hand score correlated with SJC (ρ 0.278, p = 0.020 and 0.304, p = 0.020). In men, TJC also exhibited a trend of being associated with radiographic damage (ρ 0.387, p = 0.054 for total score). Disease activity, measured by the DAS28 and DAPSA scores, correlated with radiographic scores only in men, mainly in the hands. Tenosynovitis and enthesitis were not associated with radiographic scores. Dactylitis was associated with worse radiographic outcome only in men (total radiographic score: ρ 0.547, p = 0.002; hand score: ρ 0.491, p = 0.007; foot score: ρ 0.400, p = 0.032). The 7 men with dactylitis at 5 years had a high mean score of 10. Patients in remission (no swollen or tender joints and normal ESR and CRP) at 5-year followup (n = 10) had accumulated less radiographic damage [2.7 (SD 2.5) vs 6.3 (SD 10.2), p = 0.033]. Male patients achieving minimal disease activity (MDA) according to Coates, et al22 (n = 10) clearly had less damage because the mean (SD) total score was 3.4 (2.99) in those with MDA versus 10.94 (14.36) in those not achieving MDA (p = 0.045). Hand scores were significantly lower in men with MDA (p = 0.042) than in men not achieving MDA. No difference between MDA and non-MDA was found in women.

Predicting radiographic outcome

Only 4 men (14%, 95% CI 0–27) and 17 women (40%, 95% CI 24–55) showed no signs of radiographic damage at 5-year followup (Wassenberg score ≤ 1). Thus, male sex was a risk factor for structural abnormality (OR 4.09, 95% CI 1.2–13.8, p = 0.024). Baseline and 5-year scores were highly correlated, and radiographic changes at baseline predicted further radiographic damage at followup (OR 3.4, 95% CI 2.2–5.2, p < 0.001). In age-adjusted univariate linear regression analysis, these factors significantly predicted higher 5-year radiographic scores: baseline radiographic scores, male sex, presenting with tenosynovitis at baseline, and having been treated with methotrexate (MTX; Table 4). However, in multivariate analysis, only the baseline score remained significant, explaining 64% of the total score at 5 years. In contrast, further damage was not predicted by the DAS28, SJC, TJC, HAQ at baseline, months of delay, patient age, smoking at baseline, or any enthesitis or dactylitis at baseline (Table 4).

View this table:
  • View inline
  • View popup
Table 4.

Univariate and multivariate linear regression analysis of 5-year data for all patients (n = 72), and for men and women separately.

Five-year radiographic results were not influenced by medication, other DMARD (except MTX), or the use of biologics. However, none of the 15 patients with the highest scores/most progression had received tumor necrosis factor blockers; all but 1 had been treated more or less continuously with MTX during the 5-year followup.

DISCUSSION

Radiographic destruction is an important outcome variable in clinical trials of RA and PsA. Results from our current study indicate that men improve clinically but develop radiographic changes, whereas women show less clinical improvement, especially in HAQ and TJC, but do not develop joint damage to the same extent as men. The only independent predictors of a high radiographic score at followup were elevated radiographic score at baseline and presenting with dactylitis at 5-year followup. The SJC correlated with radiographic scores, especially hand scores, primarily in men. Similarly, the DAS28 and DAPSA scores correlated with total and hand scores in men at 5-year followup. Dactylitis was also an important marker of damage, mainly in men. Patients in remission or in MDA state after 5 years had lower scores. This divergent sex-dependent behavior could be taken into consideration when planning care and treatment for patients with PsA. Women may require more interventions against functional deterioration and help coping with pain, whereas men may need followup radiography, especially in the presence of dactylitis, high disease activity, and a known propensity for radiographic destruction.

Many patients in the current study, especially women, exhibited no or very little radiographic progression. Kane, et al4 described the presentation and development of PsA over 2 years in a cohort of early PsA, demonstrating high rates of destruction in the early phase of the disease. Gladman, et al8 compared patients who had 2 years’ disease duration at the time of presentation to the arthritis clinic and those with more longstanding disease, finding that those presenting with longer symptom duration had a higher degree of damage. In that study, 39.2% of patients with early PsA presented with radiographic joint damage, compared to 49% in the current study. Queiro-Silva, et al9 studied 71 patients with early PsA over a 10-year period and found that 45% developed erosive or deforming disease by the end of the study. In that study, polyarticular disease at onset (≥ 5 swollen joints) was strongly associated with erosive disease. Similarly, Haroon, et al10 demonstrated that a delay of 6 months after symptom onset before being seen by a rheumatologist contributed to joint destruction and worse longterm physical function.

The SwePsA registry previously reported that a short delay between symptom onset and diagnosis, preserved function, and male sex are the most important predictors of a favorable clinical outcome13, and that women in general have worse outcomes with regard to clinical variables such as disease activity, pain, function, and achieving MDA13. Surprisingly, the radiographic results in the current study are discordant, in that men had higher radiographic joint scores than women, and mainly in the feet. At baseline, men presented with scores about 3 times those of female patients. The differences were also significant at 5 years.

The Wassenberg scoring system for PsA17 was selected for the current study. An advantage of the Wassenberg score is that it was specifically developed to evaluate both destructive and proliferative changes in PsA. In addition, this scoring system evaluates most hand and foot joints commonly affected by PsA (Table 1). Interphalangeal joints 2–5 in the feet are excluded from the score because they are difficult to image reliably. The Wassenberg score has a possible total score of 0 to 360; destructive changes account for 200 points and proliferative changes for 160 points. The hand score accounts for 75% of the maximum score.

In a comparison of 4 scoring systems commonly used for PsA23, the modified Steinbrocker scoring system, the modified total Sharp scoring system, the Sharp-van der Heijde modified method, and the Wassenberg scoring system were used on 50 sets of images from patients examined at 2 timepoints and read by 2 examiners. The authors concluded that none of the scoring systems were sufficiently feasible and sensitive to change to easily be applied in large longitudinal observational studies, and they could not make a clear recommendation. That study was published after most of the scoring for the current study had been performed.

Observer variation has been reported when scoring radiographs for RA24 and inflammatory changes in PsA17. In our current study, the radiographic examinations were scored in chronological order when possible. This non-random scoring order has pros and cons25, with a certain amount of expectation bias being introduced and possible overestimation of change, such as reported for scoring spinal radiographs in ankylosing spondylitis when paired scoring was preferred (the same patient’s images in unknown chronological order)26. However, chronological scoring of RA hand radiographs has been shown to increase the sensitivity for small changes between examinations, whereas a paired reading order seems to underestimate progression27.

The limitations of the current study are the small sample size due to the SwePsA protocol of performing radiography only in polyarthritic or symptomatic patients/joints. The power for detecting minor changes is lower in men because of the restricted number of male patients. The general radiographic change was modest, with most changes being technically smaller than the minimal detectable change for an individual patient17,23. In addition, the selection of patients for radiography varied somewhat because some patients underwent radiography at every visit, and some less frequently based on current clinical symptoms, probably introducing selection bias for patients with swollen and tender joints. For some patients, the analog inclusion radiographs had been destroyed or could not be located, limiting the followup time to 3 instead of 5 years, although this was overcome by imputation. Linear interpolation and extrapolation of imaging data is a well-established imputation method in both RA and PsA clinical trials28 and was done in some cases in the current study to avoid losing too many patients.

After 5 years of PsA, many patients in the current study, especially women, had no or very little joint destruction. Radiographic progression in early PsA was slow in general but substantial in men, leaving only 14% without radiographic changes at 5 years, with a high prevalence of changes in male feet. Baseline scores were the main predictor of radiographic findings at followup while the development of dactylitis may be regarded as a warning sign of possible future radiographic damage. The results in the current study suggest that for followup and treatment decisions, radiography and scoring the hands and feet at baseline are important and cannot be substituted with clinical signs, especially in men.

Acknowledgment

We acknowledge Björn Svensson for initiating the SwePsA and Gunilla Holmström for earlier fruitful cooperation and support for SwePsA.

Footnotes

  • Supported by independent grants from the Swedish Psoriasis Foundation and Skåne University Hospital “SUS FONDER.” An independent grant for partial support of this study was given by Wyeth (Pfizer).

  • Accepted for publication July 9, 2015.

REFERENCES

  1. 1.↵
    1. Scarpa R,
    2. Ayala F,
    3. Caporaso N,
    4. Olivieri I
    . Psoriasis, psoriatic arthritis, or psoriatic disease? J Rheumatol 2006;33:210–2.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Löfvendahl S,
    2. Theander E,
    3. Svensson Å,
    4. Carlsson KS,
    5. Englund M,
    6. Petersson IF
    . Validity of diagnostic codes and prevalence of physician-diagnosed psoriasis and psoriatic arthritis in southern Sweden - a population-based register study. PLoS One 2014;9:e98024.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Moll JM
    . The clinical spectrum of psoriatic arthritis. Clin Orthop 1979;143:66–75.
    OpenUrlPubMed
  4. 4.↵
    1. Kane D,
    2. Stafford L,
    3. Bresnihan B,
    4. FitzGerald O
    . A classification study of clinical subsets in an inception cohort of early psoriatic peripheral arthritis— ‘DIP or not DIP revisited’. Rheumatology 2003;42:1469–76.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Taylor WJ
    . Impact of psoriatic arthritis on the patient: through the lens of the WHO International Classification of Functioning, Health, and Disability. Curr Rheumatol Rep 2012;14:369–74.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Boehncke WH,
    2. Boehncke S
    . [Comorbidities in psoriatic arthritis]. [Article in German] Z Rheumatol 2013;72:779–83.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Hellgren K,
    2. Smedby KE,
    3. Backlin C,
    4. Sundström C,
    5. Feltelius N,
    6. Eriksson JK,
    7. et al.
    Ankylosing spondylitis, psoriatic arthritis, and risk of malignant lymphoma: a cohort study based on nationwide prospectively recorded data from Sweden. Arthritis Rheumatol 2014;66:1282–90.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Gladman DD,
    2. Thavaneswaran A,
    3. Chandran V,
    4. Cook RJ
    . Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease? Ann Rheum Dis 2011;70:2152–4.
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Queiro-Silva R,
    2. Torre-Alonso JC,
    3. Tinture-Eguren T,
    4. Lopez-Lagunas I
    . A polyarticular onset predicts erosive and deforming disease in psoriatic arthritis. Ann Rheum Dis 2003;62:68–70.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Haroon M,
    2. Gallagher P,
    3. Fitzgerald O
    . Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis 2015;74:1045–50.
    OpenUrlAbstract/FREE Full Text
  11. 11.↵
    1. Svensson B,
    2. Holmström G,
    3. Lindqvist U
    . Development and early experiences of a Swedish psoriatic arthritis register. Scand J Rheumatol 2002;31:221–5.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Lindqvist UR,
    2. Alenius GM,
    3. Husmark T,
    4. Theander E,
    5. Holmström G,
    6. Larsson PT
    . The Swedish early psoriatic arthritis register — 2-year followup: a comparison with early rheumatoid arthritis. J Rheumatol 2008;35:668–73.
    OpenUrlAbstract/FREE Full Text
  13. 13.↵
    1. Theander E,
    2. Husmark T,
    3. Alenius G-M,
    4. Larsson PT,
    5. Teleman A,
    6. Geijer M,
    7. et al.
    Early psoriatic arthritis: short symptom duration, male gender and preserved physical functioning at presentation predict favourable outcome at 5-year followup. Results from the Swedish Early Psoriatic Arthritis Register (SwePsA). Ann Rheum Dis 2014;73:407–13.
    OpenUrlAbstract/FREE Full Text
  14. 14.↵
    1. Theander E,
    2. Husmark T,
    3. Alenius G-M,
    4. Larsson PT,
    5. Teleman A,
    6. Geijer M,
    7. et al.
    The Swedish Early Psoriatic Arthritis (SwePsA) Registry. 5-year follow-up: higher disease activity, greater functional impairment and worse outcome for women compared to men [abstract]. Arthritis Rheum 2011;63 Suppl 10:S193.
    OpenUrl
  15. 15.↵
    1. Lindqvist U,
    2. Husmark T,
    3. Alenius G-M,
    4. Larsson PT,
    5. Teleman A,
    6. Geijer M,
    7. et al.
    Treatment in mono-/oligo- and polyarthritic patients: a 5-year study on the Swedish Early Psoriatic Arthritis Cohort (SWEPSA) [abstract]. Clin Exp Rheumatol 2012;30:642.
    OpenUrl
  16. 16.↵
    1. Alenius G-M,
    2. Husmark T,
    3. Theander E,
    4. Larsson P,
    5. Geijer M,
    6. Teleman A,
    7. et al.
    Rheumatoid arthritis, a more severe disease than psoriatic arthritis? A comparison of disease activity in patients with psoriatic arthritis and rheumatoid arthritis from the Swedish Early Psoriatic Arthritis Registry (SwePsA) and the Swedish Rheumatology Registry For Early Rheumatoid Arthritis (SRR) [abstract]. Arthritis Rheum 2013;65:S150.
    OpenUrl
  17. 17.↵
    1. Wassenberg S,
    2. Fischer-Kahle V,
    3. Herborn G,
    4. Rau R
    . A method to score radiographic change in psoriatic arthritis. Z Rheumatol 2001;60:156–66.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Prevoo ML,
    2. van ‘t Hof MA,
    3. Kuper HH,
    4. van Leeuwen MA,
    5. van de Putte LB,
    6. van Riel PL
    . Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38:44–8.
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Schoels M,
    2. Aletaha D,
    3. Funovits J,
    4. Kavanaugh A,
    5. Baker D,
    6. Smolen JS
    . Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis. Ann Rheum Dis 2010;69:1441–7.
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. FitzGerald O,
    2. Helliwell P,
    3. Mease P,
    4. Mumtaz A,
    5. Coates L,
    6. Pedersen R,
    7. et al.
    Application of composite disease activity scores in psoriatic arthritis to the PRESTA data set. Ann Rheum Dis 2012;71:358–62.
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    1. Taylor W,
    2. Gladman D,
    3. Helliwell P,
    4. Marchesoni A,
    5. Mease P,
    6. Mielants H,
    7. et al.
    Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54:2665–73.
    OpenUrlCrossRefPubMed
  22. 22.↵
    1. Coates LC,
    2. Fransen J,
    3. Helliwell PS
    . Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010;69:48–53.
    OpenUrlAbstract/FREE Full Text
  23. 23.↵
    1. Tillett W,
    2. Jadon D,
    3. Shaddick G,
    4. Robinson G,
    5. Sengupta R,
    6. Korendowych E,
    7. et al.
    Feasibility, reliability and sensitivity to change of four radiographic scoring methods in patients with psoriatic arthritis. Arthritis Care Res 2014;66:311–7.
    OpenUrlCrossRef
  24. 24.↵
    1. Sharp JT,
    2. Wolfe F,
    3. Lassere M,
    4. Boers M,
    5. van der Heijde D,
    6. Larsen A,
    7. et al.
    Variability of precision in scoring radiographic abnormalities in rheumatoid arthritis by experienced readers. J Rheumatol 2004;31:1062–72.
    OpenUrlAbstract/FREE Full Text
  25. 25.↵
    1. van der Heijde D,
    2. Boers M,
    3. Lassere M
    . Methodological issues in radiographic scoring methods in rheumatoid arthritis. J Rheumatol 1999;26:726–30.
    OpenUrlPubMed
  26. 26.↵
    1. Wanders A,
    2. Landewe R,
    3. Spoorenberg A,
    4. de Vlam K,
    5. Mielants H,
    6. Dougados M,
    7. et al.
    Scoring of radiographic progression in randomised clinical trials in ankylosing spondylitis: a preference for paired reading order. Ann Rheum Dis 2004;63:1601–4.
    OpenUrlAbstract/FREE Full Text
  27. 27.↵
    1. Bruynesteyn K,
    2. van der Heijde D,
    3. Boers M,
    4. Saudan A,
    5. Peloso P,
    6. Paulus H,
    7. et al.
    Detecting radiological changes in rheumatoid arthritis that are considered important by clinical experts: influence of reading with or without known sequence. J Rheumatol 2002;29:2306–12.
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. van der Heijde D,
    2. Fleischmann R,
    3. Wollenhaupt J,
    4. Deodhar A,
    5. Kielar D,
    6. Woltering F,
    7. et al.
    Effect of different imputation approaches on the evaluation of radiographic progression in patients with psoriatic arthritis: results of the RAPID-PsA 24-week phase III double-blind randomised placebo-controlled study of certolizumab pegol. Ann Rheum Dis 2014;73:233–7.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 42, Issue 11
1 Nov 2015
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Swedish Early Psoriatic Arthritis Registry 5-year Followup: Substantial Radiographic Progression Mainly in Men with High Disease Activity and Development of Dactylitis
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Swedish Early Psoriatic Arthritis Registry 5-year Followup: Substantial Radiographic Progression Mainly in Men with High Disease Activity and Development of Dactylitis
Mats Geijer, Ulla Lindqvist, Tomas Husmark, Gerd-Marie Alenius, Per T. Larsson, Annika Teleman, Elke Theander
The Journal of Rheumatology Nov 2015, 42 (11) 2110-2117; DOI: 10.3899/jrheum.150165

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
The Swedish Early Psoriatic Arthritis Registry 5-year Followup: Substantial Radiographic Progression Mainly in Men with High Disease Activity and Development of Dactylitis
Mats Geijer, Ulla Lindqvist, Tomas Husmark, Gerd-Marie Alenius, Per T. Larsson, Annika Teleman, Elke Theander
The Journal of Rheumatology Nov 2015, 42 (11) 2110-2117; DOI: 10.3899/jrheum.150165
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgment
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters

Keywords

PSORIATIC ARTHRITIS
RADIOGRAPHY
DESTRUCTION
JOINT EROSIONS
OUTCOME
DISEASE ACTIVITY SCORE

Related Articles

Cited By...

More in this TOC Section

  • Clinimetric Validation of the Assessment of Spondyloarthritis International Society Health Index in Patients With Radiographic Axial Spondyloarthritis in Ixekizumab Trials
  • Sex-Specific Differences in Patients With Psoriatic Arthritis: A Systematic Review
  • Clustering Patients With Gout Based on Comorbidities and Biomarkers: A Cross-Sectional Study
Show more Article

Similar Articles

Keywords

  • psoriatic arthritis
  • radiography
  • DESTRUCTION
  • joint erosions
  • outcome
  • disease activity score

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2022 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire