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Research ArticleArticle

Psoriatic Arthritis Mutilans: Characteristics and Natural Radiographic History

Deepak R. Jadon, Gavin Shaddick, William Tillett, Eleanor Korendowych, Graham Robinson, Nicola Waldron, Charlotte Cavill and Neil J. McHugh
The Journal of Rheumatology July 2015, 42 (7) 1169-1176; DOI: https://doi.org/10.3899/jrheum.150083
Deepak R. Jadon
From the Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Bath, UK.
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  • For correspondence: jadondr@yahoo.com
Gavin Shaddick
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William Tillett
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Eleanor Korendowych
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Graham Robinson
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Nicola Waldron
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Charlotte Cavill
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Neil J. McHugh
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Abstract

Objective. (1) To compare clinical characteristics of patients with psoriatic arthritis (PsA) with PsA mutilans (PAM) and without PAM, and (2) to determine the rate of PAM radiographic progression.

Methods. A retrospective cohort study was conducted of all patients with PsA attending a teaching hospital. The most recent hand and feet radiographs were screened for PAM. Serial radiographs (earliest to most recent) were quantitatively scored for osteolysis, erosion, joint space narrowing, and osteoproliferation.

Results. Out of the 610 cases, 36 PsA cases had PAM (5.9%). PAM cases were younger at diagnosis of PsA than non-PAM cases (p = 0.04), had more prevalent psoriatic nail dystrophy (OR 5.43, p < 0.001), and worse health assessment questionnaire score (1.25 vs 0.63, p < 0.04). Radiographic axial disease (OR 2.31, adjusted p = 0.03) and especially radiographic sacroiliitis (OR 2.99, adjusted p = 0.01) were more prevalent in PAM. PAM were more likely than non-PAM cases to have used a disease-modifying antirheumatic drug (DMARD; OR 16.36, p < 0.001). Out of 33 cases, 29 PAM cases had initiated a synthetic DMARD and 4/13 had initiated anti-tumor necrosis factor (anti-TNF) prior to first demonstration of PAM. A median 5 radiographs were scored for each PAM case (interquartile range 3–7). PAM progressed from monoarticular (60%) to polyarticular (80%) involvement. Osteolysis was initially rapid and progressive in the hands and feet, tapering later during disease course. Nail dystrophy predicted more severe osteolysis (p = 0.03).

Conclusion. Compared with non-PAM cases, PAM cases have earlier age at PsA diagnosis, poorer function, more prevalent nail dystrophy, and more radiographic axial disease/sacroiliitis. The rate of osteolysis is higher in earlier disease, and more severe in those with nail dystrophy. DMARD and anti-TNF therapy appear not to prevent PAM occurrence.

Key Indexing Terms:
  • PSORIATIC ARTHRITIS
  • NATURAL HISTORY
  • MALFORMED NAIL RADIOGRAPHS
  • TUMOR NECROSIS FACTOR-α
  • Accepted for publication March 16, 2015.
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The Journal of Rheumatology
Vol. 42, Issue 7
1 Jul 2015
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Psoriatic Arthritis Mutilans: Characteristics and Natural Radiographic History
Deepak R. Jadon, Gavin Shaddick, William Tillett, Eleanor Korendowych, Graham Robinson, Nicola Waldron, Charlotte Cavill, Neil J. McHugh
The Journal of Rheumatology Jul 2015, 42 (7) 1169-1176; DOI: 10.3899/jrheum.150083

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Psoriatic Arthritis Mutilans: Characteristics and Natural Radiographic History
Deepak R. Jadon, Gavin Shaddick, William Tillett, Eleanor Korendowych, Graham Robinson, Nicola Waldron, Charlotte Cavill, Neil J. McHugh
The Journal of Rheumatology Jul 2015, 42 (7) 1169-1176; DOI: 10.3899/jrheum.150083
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Keywords

PSORIATIC ARTHRITIS
NATURAL HISTORY
MALFORMED NAIL RADIOGRAPHS
TUMOR NECROSIS FACTOR-α

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Keywords

  • psoriatic arthritis
  • NATURAL HISTORY
  • MALFORMED NAIL RADIOGRAPHS
  • TUMOR NECROSIS FACTOR-α

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