Kane D, Stafford L, Bresnihan B, FitzGerald O
Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland.
Rheumatology (Oxford). 2003 Dec;42(12):1460-8. doi: 10.1093/rheumatology/keg384. Epub 2003 Oct 1.
To determine the clinical presentation and clinical and radiological outcome of early psoriatic arthritis (PsA) at 1 and 2 yr.
Patients with PsA were assessed at the St. Vincent's University Hospital Early Synovitis Clinic. Standardized clinical and laboratory assessment was performed at presentation and 1- and 2-yr follow-up. Radiographs of the hands and feet were evaluated in chronological order by two trained observers using the Sharp method modified to include the distal interphalangeal (DIP) joints.
A total of 129 (12.7%) of 1018 patients were diagnosed with PsA [mean age at onset of arthritis was 40.4 yr (range 11-76); mean duration of disease was 9.9 months (range 0.3-48); 52 oligoarticular, 77 polyarticular]. Means and standard deviations of indices of disease activity at presentation were: 10-cm visual analogue scale = 4.8 +/- 2.7, HAQ score = 0.71 +/- 0.64, ACR functional class III/IV = 41 (35%), Ritchie Articular Index = 5.6 +/- 6, swollen joint count = 6.9 +/- 8, erythrocyte sedimentation rate = 24 +/- 26.4 mm/h, C-reactive protein = 27.6 +/- 58.5 mg/l. At presentation, 49 (38%) patients had peripheral enthesopathy, 13 patients (10%) had inflammatory spine pain and 50 (39%) patients had DIP involvement. A total of 119 had psoriasis at the time of presentation [plaque psoriasis in 112 (94%), mean age of psoriasis onset was 29.8 +/- 16.2 yr, nail dystrophy present in 78 patients (67%)]. At 1 yr of follow-up, 119 (92%) patients were reassessed and 70 (59%) were taking a disease-modifying anti-rheumatic drug (DMARD). At 2 yr, 97 (75%) patients were reassessed and 54 (56%) were taking a DMARD. Despite considerable improvement in inflammation and function scores, only 31 (26%) patients were in remission at 1 yr with 20 (21%) in remission at 2 yr. There was a low rate of DMARD-free remission [14 (12%) at 1 yr and 11 (11%) at 2 yr]. Radiographs of hands and feet were obtained for 117 (91%) patients at presentation and 86 (67%) patients at a median follow-up of 24 months (range 11-56); 47% of patients had joint erosions in hands or feet at follow-up with a mean Sharp erosion score of 3 (0) +/- 5.2 (range 0-25) and a mean Sharp narrowing score of 3.2 (0) +/- 7.5 (range 0-48).
This study confirms that PsA is a chronic, progressive disease in the majority of patients. Despite clinical improvement with current DMARD treatment, PsA results in radiological damage in up to 47% of patients at a median interval of 2 yr.
确定早期银屑病关节炎（PsA）在1年和2年时的临床表现、临床及影像学转归。
在圣文森特大学医院早期滑膜炎诊所对PsA患者进行评估。在初诊时以及1年和2年随访时进行标准化临床和实验室评估。由两名经过培训的观察者按照时间顺序使用改良的Sharp方法评估手和足的X线片，改良后的方法纳入了远端指间关节（DIP）。
1018例患者中共有129例（12.7%）被诊断为PsA[关节炎起病的平均年龄为40.4岁（范围11 - 76岁）；疾病平均病程为9.9个月（范围0.3 - 48个月）；52例为少关节型，77例为多关节型]。初诊时疾病活动度指标的均值及标准差为：10厘米视觉模拟评分=4.8±2.7，健康评估问卷（HAQ）评分=0.71±0.64，美国风湿病学会（ACR）功能Ⅲ/Ⅳ级=41例（35%），里奇关节指数=5.6±6，肿胀关节数=6.9±8，红细胞沉降率=24±26.4毫米/小时，C反应蛋白=27.6±58.5毫克/升。初诊时，49例（38%）患者有外周附着点病，13例（10%）患者有炎性脊柱疼痛，50例（39%）患者有DIP受累。初诊时共有119例患者有银屑病[112例（94%）为斑块状银屑病，银屑病起病的平均年龄为29.8±16.2岁，78例（67%）患者有甲营养不良]。在1年随访时，119例（92%）患者接受了重新评估，70例（59%）患者正在服用改善病情抗风湿药（DMARD）。在2年时，97例（75%）患者接受了重新评估，54例（56%）患者正在服用DMARD。尽管炎症和功能评分有显著改善，但仅31例（26%）患者在1年时病情缓解，20例（21%）患者在2年时病情缓解。无DMARD缓解率较低[1年时为14例（12%），2年时为11例（11%）]。初诊时117例（91%）患者拍摄了手和足的X线片，在中位随访24个月（范围11 - 56个月）时86例（67%）患者拍摄了X线片；随访时47%的患者手或足有关节侵蚀，Sharp侵蚀评分均值为3（0）±5.2（范围0 - 25），Sharp狭窄评分均值为3.2（0）±7.5（范围0 - 48）。
本研究证实，在大多数患者中PsA是一种慢性进行性疾病。尽管目前使用DMARD治疗有临床改善，但PsA在中位2年时间内导致高达47%的患者出现影像学损害。
