Queiro-Silva R, Torre-Alonso J C, Tinturé-Eguren T, López-Lagunas I
Rheumatology Unit, Internal Medicine Service, Hospital San Agustin, Camino de Heros 4, 33400 Avilés-Asturias, Spain.
Ann Rheum Dis. 2003 Jan;62(1):68-70. doi: 10.1136/ard.62.1.68.
To analyse the factors predicting erosive-deforming arthropathy in patients with psoriatic arthritis (PsA).
A prospective cohort study was undertaken with 71 patients diagnosed as having PsA (44 men and 27 women, mean age 47 (SD 12) years). At the recruitment period patients had disease without evidence of radiological damage. Patients were studied and followed up according to a standard protocol from January 1991 to June 2001. Erosive and deforming disease was defined by the presence of erosions, joint space narrowing, subluxation, and/or ankylosis of peripheral joints. Univariate and multivariate analyses were performed to evaluate factors predicting erosive and deforming disease.
At the end of the study 32 of 71 (45%) patients had developed erosive and deforming disease. Among them, 18 of 32 (56%) had a polyarticular onset, two of 32 (6%) showed a distal interphalangeal joint disease onset, six of 32 (19%) presented with oligoarthritis, and six of 32 (19%) presented with axial disease as the form of disease onset (p=0.001). Mean time to detect erosions or joint space narrowing was 20 (SD 4) months. Men showed fewer erosions than women (p=0.05). Patients who carried the HLA-B27 antigen showed less erosive disease than patients who lacked it (p=0.05). Patients with erosive and deforming disease had poorer functional performance than those without it as measured with the Health Assessment Questionnaire (HAQ) and the American College of Rheumatology (ACR) criteria (p<0.05 with both measurements). In multivariate analysis, only a polyarticular onset remained as an indicator of erosive and deforming disease (odds ratio (OR) 37, 95% confidence interval (95% CI) 3.6 to 88, p=0.025).
A polyarticular onset (five or more swollen joints) of PsA was the unique independent risk factor which predicted the appearance of erosive and deforming disease over time. These data may be useful for clinicians treating patients with PsA, as it may guide treatment towards a more aggressive and earlier intervention.
分析银屑病关节炎（PsA）患者发生侵蚀性变形性关节病的预测因素。
对71例确诊为PsA的患者（44例男性和27例女性，平均年龄47（标准差12）岁）进行了一项前瞻性队列研究。在入组时，患者的疾病无放射学损伤证据。从1991年1月至2001年6月，按照标准方案对患者进行研究和随访。侵蚀性和变形性疾病通过外周关节存在侵蚀、关节间隙变窄、半脱位和/或强直来定义。进行单因素和多因素分析以评估预测侵蚀性和变形性疾病的因素。
在研究结束时，71例患者中有32例（45%）发生了侵蚀性和变形性疾病。其中，32例中有18例（56%）为多关节起病，32例中有2例（6%）以远端指间关节疾病起病，32例中有6例（19%）为少关节炎，32例中有6例（19%）以轴向疾病作为起病形式（p = 0.001）。检测到侵蚀或关节间隙变窄的平均时间为20（标准差4）个月。男性的侵蚀比女性少（p = 0.05）。携带HLA - B27抗原的患者比缺乏该抗原的患者侵蚀性疾病更少（p = 0.05）。与无侵蚀性和变形性疾病的患者相比，有侵蚀性和变形性疾病的患者根据健康评估问卷（HAQ）和美国风湿病学会（ACR）标准测量的功能表现更差（两种测量方法的p均<0.05）。在多因素分析中，只有多关节起病仍然是侵蚀性和变形性疾病的一个指标（比值比（OR）37，95%置信区间（95%CI）3.6至88，p = 0.025）。
PsA的多关节起病（五个或更多肿胀关节）是预测随时间推移侵蚀性和变形性疾病出现的唯一独立危险因素。这些数据可能对治疗PsA患者的临床医生有用，因为它可能指导治疗采取更积极和更早的干预措施。
