Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis

Enthesitis is an inflammatory lesion of the tendon, ligament and capsular insertions into the bone, and it is a fundamental element in the diagnosis of spondyloarthropathies. Sonography is the method of choice for studying periarticular soft tissues because it is capable of detecting both the early (oedema, thickening) and the late alterations (erosions and enthesophytes); it is also an inexpensive, biologically harmless and easily repeatable technique. The aim of this study was to compare the prevalence of quadricipital enthesitis in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients, and to document any clinical and echostructural differences in this lesion between the two diseases. The results show that enthesitis is more frequent in PsA patients, more than half of whom are asymptomatic. Knee inflammation was found in the PsA patients with enthesitis regardless of the concomitant presence of joint effusion; none of the RA patients suffered from enthesitis alone. Quadricipital enthesitis is more frequent in male patients. There was no significant correlation between the presence of peripatellar psoriatic lesions and enthesitis. Sonographic examinations of patients with enthesitis revealed that those with RA had dominantly inflammatory lesions, whereas PsA patients also showed major new bone deposition. Received: 24 January 2001 / Accepted: 15 October 2001     

Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis

Enthesitis is an inflammatory lesion of the tendon, ligament and capsular insertions into the bone, and it is a fundamental element in the diagnosis of spondyloarthropathies. Sonography is the method of choice for studying periarticular soft tissues because it is capable of detecting both the early (oedema, thickening) and late alterations (erosions and enthesophytes); it is also an inexpensive, biologically harmless and easily repeatable technique. The aim of this study was to compare the prevalence of quadricipital enthesitis in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) patients, and to document any clinical and echostructural differences in this lesion between the two diseases. The results show that enthesitis is more frequent in PsA patients, more than half of whom are asymptomatic. Knee inflammation was found in the PsA patients with enthesitis regardless of the concomitant presence of joint effusion; none of the RA patients suffered from enthesitis alone. Quadricipital enthesitis is more frequent in male patients. There was no significant correlation between the presence of peripatellar psoriatic lesions and enthesitis. Sonographic examinations of patients with enthesitis revealed that those with RA had predominantly inflammatory lesions, whereas PsA patients also showed major new bone deposition. Received: 24 January 2001 / Accepted: 16 January 2002     

Serum transferrin receptor levels in patients with rheumatoid arthritis are correlated with indicators for anaemia

To measure serum soluble transferrin receptor (s-TfR) levels in patients with rheumatoid arthritis (RA), sera were obtained from 50 Japanese RA patients and 20 healthy subjects. Both s-TfR and serum erythropoietin (EPO) levels were measured by enzyme-linked immunosorbent assay (ELISA). Routine laboratory tests were also performed, including peripheral blood analysis and determination of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), serum iron levels, total iron-binding capacity (TIBC) and serum ferritin levels. The s-TfR levels in the 50 RA patients (mean ± SD, 1801 ± 512 ng/ml) were significantly higher than those in the 20 control subjects (1316 ± 345 ng/ml). There were no differences in the values of s-TfR between men and women in either group, or between RA patients over and under 50 years old. Serum EPO levels in 47 RA patients were as low as 14.0 ± 10.1 mIU/ml (mean ± SD), ranging from 3.9 to 58.7 mIU/ml (normal range 2.8–17.2 mIU/ml), unrelated to low haemoglobin concentration. The s-TfR levels in RA patients showed negative correlations with red blood cell count, serum iron level and haemoglobin concentration, and positive correlations with ESR and serum EPO levels. However, there were no correlations between s-TfR level and markers of inflammation such as CRP, platelet count or RF titre. In conclusion, s-TfR level in RA patients could be a marker of erythropoiesis rather than of joint inflammation. Received: 14 September 2000 / Accepted: 15 March 2001     

Lipoprotein(a) and Lipids in Relation to Inflammation in Rheumatoid Arthritis

The aim of this study is to evaluate whether lipoprotein(a) (Lp(a)) acts as the acute phase reactant and whether changes of lipids are related to inflammation in rheumatoid arthritis (RA). Lp(a) and lipids were measured after an overnight fast, before and after 14 days use of antiinflammatory agents and correlated with laboratory findings in 21 untreated RA patients and 19 healthy controls. Nine (42.3%) of 21 RA patients and 6 (31.6%) of 19 controls had high Lp(a) levels (> 30 mg/dl) and the Lp(a) level was higher in RA patients compared with controls (27.1 ± 5.3 vs 19.0 ± 4.2 mg/dl) without significant difference (p > 0.05). There was no significant correlation between ESR and Lp(a) and lipids in RA patients except for HDL cholesterol (r=–0.563, p = 0.008). After antiinflammatory agent use for 14 days, change in ESR (ESRsample1–ESRsample2) was significantly and negatively correlated to changes in total and HDL cholesterols in RA patients. In conclusion, although Lp(a) tended to be higher in RA, we could not find a distinct acute phase pattern of Lp(a). But changes in total and HDL cholesterols were negatively correlated with inflammation in RA. Our data support the phenomenon that dyslipoproteinemia observed in RA is associated with inflammation. Received: 6 August 1999 / Accepted: 25 January 2000     

Psoriatic Arthritis: Interrelationships between Skin and Joint Manifestations Related to Onset,Course and Distribution

To assess the relationships between skin and joint disease, 70 patients with psoriatic arthritis were consecutively evaluated. Data were obtained regarding age, sex, duration of disease, age at onset, and flares of both skin and joint disease. Rheumatological assessment included morning stiffness, number of swollen, tender and deformed joints, involvement of distal interphalangeal joints (DIP), presence of dactylitis, Achilles tendinitis, and clinical lumbar and cervical involvement. Skin assessment included recording of the distribution of skin lesions and nail involvement, and grading of psoriasis severity using the PASI. The scalp was the most frequently involved site. Significant correlation was found between the PASI score and the number of deformed joints and Schober’s test. The scalp score was found to correlate with the number of swollen joints, deformed joints, sausage finger and DIP involvement. Synchronous flares of skin and joint were significantly more frequent in the patients with onset of skin and joint diseases within the same year. Likewise, these patients showed a highly significant association between the PASI score and the number of tender, swollen and deformed joints, Schober’s test and cervical involvement, whereas no such associations were found among patients with separate onset of skin and joint diseases. Received: 9 August 1999 / Accepted: 10 February 2000     

Subsets in Psoriatic Arthritis formed by Cluster Analysis

The aim of the study was to create subgroups among psoriatic arthritis patients on the basis of dermatological features, clinical pattern of arthritis, and laboratory, immunological and radiological findings. Data on 100 patients were expressed in a standardised form and entered into hierarchical cluster analysis according to Ward”s method. Seven subgroups were created. Fifty-six patients with mild psoriasis were sorted into a “polyarticular group”. Two “RA-like groups” were formed, differing from each other serologically and in axial involvement. In an “oligoarticular group” (18 patients) serious skin disease and female gender predominancy were found to be characteristic. Eight patients with polyarticular arthritis were assigned to an “erythrodermal group”, in which polyarticular arthritis, mutilating, severe arthritis and a history of erythroderma were characteristic. Close to this group on the dendrogram eight women were sorted into a “distal form”. Sausage fingers were frequent, and nail dystrophy was present in every case. In a “pustular group” (three patients) the different type of skin involvement was considered and nail dystrophy was common. In the newly created subgroups not only the arthritic status, but also the type of the skin disease, played a determining role. Received: 23 November 1999 / Accepted: 7 July 2000     

Disease manifestations and HLA antigens in psoriatic arthritis in northern Sweden

The aim of this study was to identify potential markers of aggressive joint manifestations and HLA associations in patients with psoriatic arthritis (PsA) in northern Sweden. Patients with PsA were examined clinically, with laboratory tests and radiologically. The classification of the disease was based on peripheral and/or axial engagement. HLA B17, B37 and B62 were significantly increased in PsA patients. Univariate analyses suggest that the HLA antigens B37, B62 and some clinical variables were associated with disease course. However, in multivariate analyses distal interphalangeal joint affliction and polyarticular manifestations were the only variables remaining significantly associated with irreversible joint destruction or deformity. There were no significant effects of HLA antigens. In this cross-sectional study, clinical manifestations were more reliable predictors of aggressive joint damage than were specific HLA antigens. However, HLA antigens seemed to modify the expression of the joint disease rather than being involved in joint disease susceptibility. Received: 13 August 2001 / Accepted: 11 February 2002     

Effect of intensive lipid‐lowering therapy on cardiovascular outcome in patients with and those without inflammatory joint disease

Objective

To examine the effect of intensive lipid‐lowering therapy on a composite cardiovascular outcome (cardiovascular disease [CVD]), consisting of mortality and morbidity end points, in patients with inflammatory joint disease (rheumatoid arthritis [RA], ankylosing spondylitis [AS], or psoriatic arthritis [PsA]) by post hoc analysis of 2 prospective trials of statins with a secondary end point of CVD outcome (the Treating to New Targets [TNT] and Incremental Decrease in End Points Through Aggressive Lipid Lowering [IDEAL] studies).

Methods

Of the 18,889 patients participating in the 2 trials, 199 had RA, 46 had AS, and 35 had PsA. Lipid‐lowering therapy consisted of an intensive regimen of atorvastatin 80 mg or a conventional/low‐dose regimen of atorvastatin 10 mg or simvastatin 20–40 mg. The median duration of followup was nearly 5 years. Changes in lipid levels were examined by analyses of covariance. The effect on CVD was examined by Cox regression analyses, and heterogeneity tests were performed.

Results

Patients with RA and those with AS had lower baseline cholesterol levels than patients without inflammatory joint disease (least squares mean ± SEM 180.7 ± 2.3 mg/dl and 176.5 ± 4.7 mg/dl, respectively, versus 185.6 ± 0.2 mg/dl; P = 0.03 and P = 0.05, respectively). Statin treatment led to a comparable decrease in lipid levels and a 20% reduction in overall risk of CVD in both patients with and those without inflammatory joint disease.

Conclusion

Our findings indicate that patients with and those without inflammatory joint disease experience comparable lipid‐lowering effects and CVD risk reduction after intensive treatment with statins.

     

Treatment of psoriatic arthritis with TNF alpha-antagonists

The proinflammatory cytokine TNF alpha is in the pathogenesis of PsA as important as in RA. TNF-alpha is increased in the psoriatic skin lesion and in the synovium of the inflamed joint. The TNF alpha blockage has been tested in double blind trials with etanercept and infliximab. All studies proved a significant and durable response in the reduction of synovitis in a comparable extend in both drugs. Etanercept showed after 12 weeks an ACR20 response in 59% of the patients versus 15% in the placebo arm. Infliximab had after 14 weeks a 69% ACR20 response versus 8% placebo response. The psoriatic skin lesion improved with both drugs. The PASI was reduced by 47% with etanercept and by 81% with infliximab. The safety-profile was similar to the RA-trials. For etanercept the one year data have shown a reduction in x-ray progression. Etanercept has been approved in the USA and in Europe.     

Distribution of Double-Negative (CD4−CD8−, DN) T Subsets in Blood and Synovial Fluid from Patients with Rheumatoid Arthritis

Double-negative (CD4⁻CD8⁻) T (DNT) cells have been postulated to be potentially autoreactive. However, the role of DNT cells in rheumatoid arthritis (RA) has received limited attention. We investigated the distribution of DNT subsets in peripheral blood (PB) and synovial fluid (SF) from patients with active RA to determine whether these cells have relevance to RA. Two-colour flow cytometric analysis was performed to detect DNT cells in PB from 35 RA patients, 26 healthy controls and in SF aspirated from 19 inflamed rheumatoid joints. The subsets of DNT cells, i.e those expressing T cell receptor αβ (αβDNT) or γδ (γδDNT) were simultaneously examined. Our results showed that DNT cells constituted a very minor subset of PB lymphocytes. When expressed as a percentage of total lymphocytes, αβDNT levels in normal individuals ranged from 0.27 to 2.08% ( average 0.76%), while those of γδDNT ranged from 1.02 to 11.42% (average 3.23%). Compared with normal individuals, RA patients had a similar distribution of αβDNT cells in both PB and SF. However, RA patients had significantly lower levels of γδDNT cells in PB than control subjects (1.38 ± 1.08% vs 3.23 ± 2.12%, p<0.05), while the levels of γδDNT cells in SF of RA patients were higher than those in PB from RA patients and normal controls. The difference between PB and SF in RA was statistically significant (3.90 ± 1.88% vs 1.38 ± 1.08%, p;<0.05). A higher level of γδDNT in SF than their paired PB was consistently noted from nine available paired samples. Our findings suggest that γδDNT cells, but not αβDNT cells, are probably relevant to RA. The lower percentage of circulating γδDNT cells might have resulted from migration from the circulation into the synovium, suggesting a role for γδDNT cells in the pathogenesis of rheumatoid synovitis. Received: 30 June 1998 / Accepted: 4 January 1999     

Interleukin-2 Levels are Elevated in the Bone Marrow Serum of Patients with Mutilans-Type Rheumatoid Arthritis

In order to investigate the pathogenesis of mutilans-type rheumatoid arthritis (RA), we measured cytokine levels in the bone marrow serum of patients with RA. We studied 35 patients with non-mutilans RA, 19 with mutilans RA, and 20 patients with osteoarthritis (OA) undergoing joint surgery. At the time of surgery, iliac bone marrow and peripheral blood were sampled from all 74 patients and cytokine levels measured. The serum levels of five cytokines (IL-1β, IL-2, IL-3, IL-6 and GM-CSF) were measured by ELISA. Haematologic and inflammatory factors were also measured. Levels of IL-2, IL-6 and GM-CSF in bone marrow serum were significantly higher in all RA patients than in those with OA. Mean (tSD) IL-2 levels were significantly higher in patients with mutilans-type RA (309.8t686.3 pg/ml) than in patients with other types of RA (66.5t173.1 pg/ml; P<0.01). IL-2 was detected significantly more often in patients with mutilans-type RA than in patients with other types of RA (P<0.01). Inflammatory factors were higher in all RA groups than in OA patients. However, the haematologic and immunologic variables were no different between mutilans RA and other types of RA. No correlations were observed between IL-1β, IL-2, IL-3, IL-6 and GM-CSF levels and these laboratory variables. In patients with mutilans-type RA, IL-2 levels in the bone marrow serum were significantly higher than in patients with other types of RA or with OA. This elevation does not appear to be related to systemic inflammation, as there was no correlation with other inflammatory factors. Received: 9 October 2000 / Accepted: 16 July 2001     

Release of cartilage and bone macromolecules into synovial fluid: differences between psoriatic arthritis and rheumatoid arthritis

OBJECTIVE: To elucidate whether differences in the destructive tissue process in cartilage and bone in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) can be recognised by different release patterns of molecular fragments derived from joint tissue. METHODS: Aggrecan, cartilage oligomeric matrix protein (COMP), and bone sialoprotein (BSP) were quantified by immunoassays in knee joint synovial fluid samples. These were obtained early in the disease course of patients with PsA and RA. At the time of arthrocentesis radiographs of their knee and hip joints were normal. RESULTS: At follow up no destruction had developed in the knees and hips of most patients with PsA (n=18), whereas the patients with RA could be separated into one "destructive" group (n=18) and one "non-destructive" group (n=25). Patients with PsA had low synovial fluid aggrecan concentrations (p<0.001 v the RA destructive group) but high COMP concentrations (p<0.01 and p<0.05 v destructive and non-destructive RA groups, respectively). Consequently, the aggrecan/COMP ratio was lowest in the PsA group (p<0.001 and p<0.01 v the destructive and non-destructive RA group, respectively). The synovial fluid concentrations of BSP did not differ between the three patient groups. CONCLUSIONS: The release pattern of aggrecan and COMP, reflecting cartilage turnover, differed between the PsA group and, particularly, the destructive RA group. This suggests that different pathophysiological mechanisms for cartilage involvement operate in these conditions, with different destructive potential. The BSP concentrations did not differ between the patients groups, which indicates similar levels of bone involvement.     

The Effect of Melatonin in Patients with Fibromyalgia: A Pilot Study

The aim of the study was to determine the possible effect of melatonin treatment on disturbed sleep, fatigue and pain symptoms observed in fibromyalgia (FM) patients. Twenty-one consecutive patients with FM were included in an open 4-week-duration pilot study. Before and after treatment with melatonin 3 mg at bedtime, patients were evaluated using tender point count by palpation of 18 classic anatomical regions, pain score in four predesignated areas, pain severity on a 10 cm visual analogue scale (VAS), sleep disturbances, fatigue, depression, anxiety, and patient and physician global assessments, also by a VAS. Urine 6-sulphatoxymelatonin levels (aMT-6S) were measured in the patients and 20 age- and sex-matched controls. Nineteen patients completed the study. One patient withdrew because of migraine and another was lost to follow-up. At day 30, median values for the tender point count and severity of pain at selected points, patient and physician global assessments and VAS for sleep significantly improved with melatonin treatment. Other variables improved but did not reach statistical significance. Adverse events were mild and transient. Lower levels of aMT-6S were found in FM patients compared with normal median controls (±SD, 9.16 ± 7.9 μg/24 h vs 16.8 ± 12.8 μg/24 h) (p= 0.06). Although this is an open study, our preliminary results suggest that melatonin can be an alternative and safe treatment for patients with FM. Double-blind placebo controlled studies are needed. Received: 14 September 1998 / Accepted: 14 May 1999     

Spot Urine Concentrations of Type I Collagen Cross-Linked N-Telopeptides and Deoxypyridinoline in Psoriatic Arthritis

The main objectives of this study were to investigate whether the spot urine concentrations of type I collagen cross-linked N-telopeptides (NTx) and deoxypyridinoline (Dpd) can be used to distinguish between active and suppressed disease in psoriatic arthritis (PsA) and to study the relationship between these markers of bone resorption and disease activity indices. Using enzyme-linked immunosorbent assays, concentrations of NTx and Dpd were estimated in spot urine samples from 25 patients with active disease, 10 patients with suppressed disease and 35 age- and sex-matched healthy control subjects. In patients with active disease, urine concentrations of NTx and Dpd were significantly elevated (p<0.001) compared with healthy controls and there were no significant differences (p>0.05) when compared with those with suppressed disease. In active disease, there was no significant positive correlation between urinary NTx and erythrocyte sedimentation rate (ESR) (r= 0.025, p>0.05) nor between Dpd and ESR (r=−0.208, p>0.05). In conclusion, NTx and Dpd concentrations in spot urine have no association with disease activity in patients with PsA. Received: 10 November 1998 / Accepted: 11 May 1999     

A comparative evaluation of quality of life and life satisfaction in patients with psoriatic and rheumatoid arthritis

Both rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have a negative impact on patients’ quality of life (QOL). The aim of this study was to compare QOL and life satisfaction in patients with RA and PsA. Forty patients with PsA, 40 patients with RA, and 40 healthy control subjects were included in the study. Demographic data and clinical characteristics including age, sex, disease duration, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), peripheral pain assessed by visual analog scale (VAS) and Larsen scores of hand X-rays were recorded. Nottingham Health Profile (NHP) was used to evaluate QOL, and Life satisfaction index (LSI) was used to measure psychological well-being in both groups. The demographic data of the subjects were similar between the groups. The scores of all NHP subscales were significantly higher and the scores of LSI were significantly lower in PsA and RA patients than in control subjects. The inflammation markers including ESR, CRP, pain by VAS and Larsen scores were found to be significantly higher in RA patients. The scores of LSI were similar between the groups. Although the scores of physical domains of NHP (pain and physical disability) were statistically higher in RA patients (p<0.05), the scores of psychosocial subgroups of NHP were similar between RA and PsA patients (p>0.05). Both PsA and RA patients had disturbed QoL and decreased life satisfaction. In conclusion, peripheral joint damage, inflammation, and physical disability are significantly greater in RA but psychosocial reflection of QOL and life satisfaction are the same for both groups which can be explained by the additional impact of skin disease in patients with PsA.     

Outcome-Parameter bei Psoriasisarthritis

The most important and most commonly occurring form of psoriasis is psoriasis vulgaris. In the specialism of rheumatology palmoplantar pustulosis is also important. The outcome is influenced mainly by how severe and how widespread the manifestations affecting the skin and nails are. All manifestations affecting the joints and occurring in association with psoriasis are subsumed under the term ‘psoriatic arthritis’ (PsA). Asymmetric oligoarthritis, enthesitis and inflammatory spinal manifestations are especially frequent. PsA is a rheumatic illness with widely varying clinical pictures, most patients having signs and symptoms resembling those of spondyloarthritides (SpA) and other features of rheumatoid arthritis (RA) and/or of arthrosis/osteoarthritis (OA). Clinical features that are particularly typical of PsA are ray-wise joint involvement, dactylitis and osteodestructive and osteoproliferative joint destruction. Dactylitis, asymmetric joint involvement and enthesitis also occur in other SpA. It is becoming increasingly important to define outcome parameters for use in PsA against the backdrop of new forms of treatment. In the case of clinical outcome basic distinctions must be made between clinical signs and symptoms, function and structure. In PsA the sometimes significant manifestations affecting skin and nails must also be considered. The outcome parameters used thus far have varied very widely. The extent and intensity of involvement of the peripheral joints and insertions of tendons and of spinal involvement are particularly important in PsA. In addition, functional impairments, quality of life and parameters concerned with work must be considered. There are hardly any measuring instruments specific to PsA; many have been developed and used primarily for SpA or RA.     

Human leukocyte antigen distribution in Israeli patients with psoriatic arthritis

Objectives This study was designed to investigate the distribution of human leukocyte antigen (HLA) classes I and II in a group of Israeli Jewish patients with psoriatic arthritis (PsA) and identify HLA markers related to disease manifestation in PsA.Patients and methods Human leukocyte antigens class I and class II (both serologically and from oligotyping) were tested in a group of 50 consecutive patients with PsA, 32 with skin psoriasis (PSO), and 255 healthy persons. Data on age, gender, disease duration, and pattern of rheumatological manifestations—oligoarthritis, polyarthritis, spinal involvement, involvement of distal interphalangeal joints (DIPs), and enthesitis—were registered.Results Human leukocyte antigens A3, B13, and B38 alleles were found to be significantly prevalent in PsA compared with PSO patients and healthy controls. HLA-B27 was found in only two out of 50 patients with PsA. Patients with PSO and PsA had significantly increased incidence of HLA-DRB0101 and -DRB0301, while the frequency of HLA-DRB0403 was significantly higher among patients with PsA of Ashkenazi origin. We found a statistically significant association between DIP involvement and the presence of HLA-A26 and -B38, while HLA-DRB0301 was related to spinal involvement.Conclusions Psoriatic arthritis in Israeli patients seems to be associated with the presence of HLA-A3, -B13, -B38, -DRB0101, and -DRB0301. HLA-B27 was not a marker of PsA in this cohort of patients, including patients with psoriatic spondyloarthropathy.     

Comparison of disability and quality of life in rheumatoid and psoriatic arthritis

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.     

Rheumatoid factors in psoriatic arthropathy and in Waaler-Rose negative rheumatoid arthritis

Summary Serum levels of IgG, IgA and IgM rheumatoid factor (IgG RF, IgA RF and IgM RF) were determined by means of the diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA) in 42 Waaler-Rose negative patients with psoriatic arthropathy (PsA) type 1 (arthritis with involvement of distal interphalangeal joints) and type 3 (polyarthritis of rheumatoid type) according to the criteria of Moll and Wright as well as in 53 patients with Waaler-Rose negative rheumatoid arthritis (RA). Elevated levels of RF were found in 22% of patients with PsA type 3 and 45% of patients with Waaler-Rose negative RA. In contrast, none of the patients with PsA type 1 had detectable amounts of RF. It is suggested that the presence of IgG, IgA or IgM RF in patients having psoriasis in conjunction with inflammatory polyarthritis indicates the RA nature of the joint disease and should be considered as exclusion criterion for the diagnosis of PsA.     

Disease burden of psoriatic arthritis compared to rheumatoid arthritis, Hungarian experiment

The objectives of this study were to assess the costs of psoriatic arthritis (PsA) in Hungary and to identify key cost drivers among demographic and clinical variables and to compare cost-of-illness of PsA and rheumatoid arthritis (RA). Cross-sectional retrospective survey of 183 consecutive patients from eight rheumatology centres was conducted. Mean direct medical, direct non medical, indirect and total costs were 1,876, 794, 2,904 and 5,574 euros/patient/year, respectively. Total costs were in significant linear relationship with health assessment questionnaire score and psoriatic area severity index. Costs of RA were higher in all domains than of PsA. Our study was the first from the Eastern European region that provides cost-of-illness data on PsA. Our study revealed that functional status and severity of skin symptoms were the key cost drivers. The costs of PsA in Hungary were lower than in the high-income European countries.