RESEARCH - Polyarticular psoriatic arthritis is more like oligoarticular psoriatic arthritis than RA

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Ann Rheum Dis. 2006 Jul 13; [Epub ahead of print]

Polyarticular psoriatic arthritis is more like oligoarticular psoriatic

arthritis, than rheumatoid arthritis.

Helliwell PS, Porter G, WJ.

Institute of Musculoskeletal and Rehabilitation Medicine, University of

Leeds, United Kingdom.

BACKGROUND: Since the original description of psoriatic arthritis sub-groups

by Moll and there has been some discrepancy in the precise frequency

of the different sub-groups and in particular the proportion of cases with

polyarthritis. The higher frequency of the polyarthritis sub-group may be

due to the inclusion of cases with seronegative rheumatoid arthritis with

co-incidental psoriasis. The CASPAR study database provided an opportunity

to examine this question. METHODS: The CASPAR study collected clinical,

radiological and laboratory data on 588 patients with physician diagnosed

psoriatic arthritis (PsA) and 525 controls with other inflammatory

arthritis, 70% of which had rheumatoid arthritis. Case of PsA were divided

into two groups: polyarthritis and non-polyarthritis (which included the

Moll and sub-groups of spinal disease, distal interphalangeal

predominant and arthritis mutilans) and were compared to cases of rheumatoid

arthritis (RA). Comparisons were made between all three groups and, if a

significant difference occurred, between the two groups of PsA. RESULTS: The

three groups differed significantly with regards to all clinical and

laboratory variables except duration of disease. Significant differences

were also found between the two groups of PsA in terms of age, gender, total

number of involved joints, disability score, and symmetry. However, there

were no differences between the groups of patients with PsA in terms of

seropositivity for rheumatoid factor and antibodies to cyclic citrullinated

peptide, enthesitis, and spinal pain and stiffness. Further, dactylitis was

commonly seen in PsA (57% in polyarticular group, 45% in non- polyarticular

group) and uncommonly found in RA (5%). With the exception of entheseal

changes, syndesmophytes and osteolysis, typical radiological features of PsA

were again unable to distinguish between the PsA subgroups.

CONCLUSIONS: There is no evidence that the changing frequency of the

polyarticular sub-group of psoriatic arthritis is due to physicians

including cases of seronegative rheumatoid arthritis with co-incidental

psoriasis.

PMID: 16840501

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6840501

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