Sokoll K B, Helliwell P S
Department of Rheumatology, St Luke's Hospital, Bradford, UK.
J Rheumatol. 2001 Aug;28(8):1842-6.
There is controversy about the severity of peripheral psoriatic arthritis (PsA) compared to rheumatoid arthritis (RA). Early reports found PsA to be a milder disorder, excepting the mutilans form. Recent reports suggest that PsA can be as severe as RA. We compared severity, disability, and quality of life in patients with PsA and RA matched primarily for disease duration.
Data relating to the extent and severity of disease were recorded in a hospital clinic setting. Recent radiographs of hands and feet were read blinded to diagnosis, and information on function and quality of life was collected with the Health Assessment Questionnaire (HAQ) and EuroQol-5D, respectively.
Forty-seven patients were matched for disease duration (median PsA 5 yrs, RA 7 yrs). The male/female ratio was 24/23 for PsA, 16/31 for RA, and median ages were 45 and 51 years, respectively. Patients with RA had significantly more joint involvement of metacarpophalangeal joints and wrists, whereas distal interphalangeal joints, spine, sternoclavicular joints, and sacroiliac joints were significantly more involved in PsA. No difference was found regarding Ritchie Articular Index, inflammatory markers, HAQ score, or EuroQol-5D. Patients with RA had significantly more damage on radiographs of hands and feet: median (range) Larsen score hands PsA 8 (0-91), RA 38 (0-125); feet PsA 4 (0-34), RA 11(0-56). Patients with RA were taking significantly more disease modifying drugs.
Peripheral joint damage is significantly greater in RA than in PsA after equivalent disease duration, but function and quality of life scores are the same for both groups. The additional burden of skin disease in PsA may account for this.
与类风湿关节炎（RA）相比，外周型银屑病关节炎（PsA）的严重程度存在争议。早期报告发现，除毁形性关节炎外，PsA是一种较轻的疾病。近期报告表明，PsA可能与RA一样严重。我们比较了主要根据病程匹配的PsA和RA患者的严重程度、残疾情况及生活质量。
在医院门诊环境中记录与疾病范围和严重程度相关的数据。对双手和双足的近期X线片进行盲法读片以确定诊断，并分别使用健康评估问卷（HAQ）和欧洲五维健康量表（EuroQol-5D）收集功能和生活质量方面的信息。
47例患者病程匹配（PsA中位数为5年，RA中位数为7年）。PsA组的男女比例为24/23，RA组为16/31，中位年龄分别为45岁和51岁。RA患者掌指关节和腕关节的关节受累明显更多，而PsA患者的远端指间关节、脊柱、胸锁关节和骶髂关节受累明显更多。在里奇关节指数、炎症标志物、HAQ评分或欧洲五维健康量表方面未发现差异。RA患者双手和双足X线片上的损伤明显更多：双手Larsen评分中位数（范围），PsA为8（0-91），RA为38（0-125）；双足PsA为4（0-34），RA为11（0-56）。RA患者服用改善病情药物的比例明显更高。
病程相当的情况下，RA患者外周关节损伤明显比PsA患者更严重，但两组的功能和生活质量评分相同。PsA中皮肤病的额外负担可能是其原因。
