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61 1) €9 ‘9660 ‘P41 PAY nyy voy LID £9 9668 TH pug] “wennyy “ay S66 2z sysondos lay ‘soot ‘stad momposion sof pas sraonin id 29 pons sary ye] ‘soguue ssugruosd buys dLagd SuoIsaT 59] 1S onbis ap -04988 599 OF say suep yuosratie,s sant sadno.8 august -ojorpea a4098 np asnreats1Us sed rear dat 1 f9saa0uL LV “(S00 0 ~joay ne odes aed adnoa® suuarenb 9} sep, adnoss 0° > d) royasd ne jz0ddea 2 1 af Sue anoqandns yuoWwAnEarTN: anbySojorpea aaoas 97] “apepeut ey ap HuESsIOA9 PlauuaioMe,| uopas xneay syHoaIF0,p “sadnos f ua sgandgs 939 1u0 syn a409s me Ja sanbySoporpes suON EID: aaia.i0s 1eq9 aIpepeU EL ap paUALAIDIEE,| anos, ‘siuajed gg 2249 spjaosse juanEAD (Saxp -uS nopa snd Jo ¢ apeIs “I}eADIEHUN nO Z apes sopeagie -o4aes) xmepxe. yo sonbiigydiayd sanbiSojolpea saudls soq “uasae7] ap opourout be] uojas anbrSojorpes auogs af 49 umgUEDTEI Mp 9 uysseq np sompedospyyua,p aaquuoM aq *sor peaayduid SUBDYIUSIS JOU SEA So[BAENb pany puE PUODs au} uaasiioq aauaIaIp au] SkAIMA “(SOO0'0>d) aipaenb pay ayy wy weyy yranoy ayy uy pur (soo'y>d) aiaenb say ayy uF ueY) puosds dq UT soMPny SpUeyrUIS aq 0} Punoy SEA 24095 Suoneinp spiiyzaesjod uo paseq Popiaip dom squaed UoY AL ‘auoas asnasip ay) pur soSunya (earSoporpta TPH parepa.cios sea uonwanp aseasta “GaLigd -olusapuss a0jpue es 940UM 10 ¢ OBEYS Te josoes 7 adieys yeuaiuyiq) sasuRND joys fesoydziad yjoq pry swuoned Supt "9.4098 9BeurEp s,uasser] pues -osaijyaa [eameavea pur afsfod Jo soquinu ‘soncyd ouusopugs yo aaquinu ‘eps syuoAdes ‘su01s9] Jo AqH9sas “aay pur spuey ay Jo SITIO! UT aqouieard siuaned opt Spmys axpoadsonna © iaxas of UEy [E9150] ~OIper [RINE Ip} SUONE|aL09 pu ALIAS “SoHE 99U3.1N990 OF Jaadsar YPM paywsNsoauy a30M saunyo (woytojorpea pesaydtaad —"RAVINIVAS PUTIDA HHAIRA TOUVAVES CMOMY “RAVDIVE. Ow, «SLLRIH LE VATOd OLLVIIOSd HLM S.LNALLWd NI SIDNVHD TWOIDOTOIVY TVIXY CNV TWUdHd Ad NIAM LAG SNOLLY TAYOD 9661 ‘20544 snbyfyua;rs vensekCy 9 Siannaryend both peripheral and axial changes contribute to the severity of psoriatic polyarthritis and that the subgroup of patients with axial changes is characterized by more frequent and more seve- re peripheral lesions. Jo TACCARY, Antonio SPADARO, Yoeria RICCHERE REVUE DU RHUMATISME Tenge) I4NUARY 1996 Risen iaques s'aggrave seulement dans les formes les plus anciennes. Ila été mis en évidence, chez, Fensemble des patients, une corrélation entre la sévérité des anomalies périphériques, le stade de la sacro-iliite et le score radiologique. Les lesions périphériques ont été plus frequentes et séveres et le score radiologique plus élevé (p< 0,00001) quand coexistaient des lésions axiales, Nos résultats suggérent que les atteintes axiales et périphériques participent ensemble & Ia sévérité des polyarthrites psoriasiques et que Teur coexistence définit un sous-groupe de patients dont les Iésions périphériques sont plus séveres. Key words: Pso1 changes - Correlations - Psoriasis. - Radiological Mots clés: Rhumatisme psoriasique - Polyarthrite - Lésions radiologiques - Corrélations - Psoriasis. The classification of psoriatic arthritis subsets is currently under debate. The criteria of Moll and ‘Wright [1] have been revisited by Hellivell et al [2] who suggested that only three subsets should be differentiated. Helliwell et al. underlined the high incidence of symmetric or asymmetric per- ipheral joint involvement in psoriatic arthritis and pointed out that some patients have both peripheral fand axial joint lesions as well as extraarticular bone changes. They found that peripheral arthritis was less common in patients with spinal involve- ment and that the pattern of joint lesions was remi- niscent of theumatoid arthritis (2]. No data are available on the severity of peripheral lesions in psoriatic arthritis with or without axial involve ment and on correlations between various axial fand peripheral radiological changes. We studied a group of patients with polyarticular psoriatic arthritis with or without axial involvement in order to evaluate the occurrence and severity of periphe- ral radiological lesions and to investigate correla tions between peripheral and axial radiological changes PATIENTS AND METHODS: We conducted a retrospective study of 140 patients with psoriatic polyarthritis (more than four Joints) with or without axial changes (sacroiliitis ‘and/or syndesmophytes). The female-to-male ratio was 0.68 (53/87), mean age was 47.0 years (range 33-74 years), mean age at onset was 40.7 years (range 20-73 years), and mean disease duration was 64 years (range 0.2-21). All study patients met the criteria of Moll and Wright [1] for psoria- sis of the skin and/or nails with inflammatory. pet- ipheral andior axial arthritis, and all bad persistent Iy negative findings from latex and ELISA tests for rheumatoid factor. At the time of assessment, 91% of patients had psoriasis vulgaris, 6% had guttate psoriasis, and 3% had normal skin but had nail lesions (pitting and/or onycholysis) and a history of psoriasis vulgaris. Routine laboratory tests and Standard radiographs of the hands, wrists, feet, ankles, pelvis, and three spinal segments were done in all patients. Radiographs were scored inde~ pendently by two of us, who were blinded to patient identity. We determined the number of ero- Sions of the distal and proximal interphalangeal joints of the hands, metacarpophalangeal joints [3], proximal interphalangeal joints of the feet, and metatarsophalangeal joints, We also evaluated the severity of wrist involvement [3] and the sacroilii~ tis stage [4]. Any marginal or paramarginal syn~ desmophytes and pelvic and/or calcancal tenthesopathies [5,6] were noted. Marginal syndes- mophytes were defined as vertebral ossifications arising from the edge of the vertebral body and forming a fine, vertical, intervertebral bridge. Paramarginal syndesmophytes were broad, coarse ossifications that arose at a distance from the edge of the vertebras. Syndesmophytes were distingui- shed from osteophytes, which originate from the eartilaginous endplate and are wider, horizontally- oriented, and accompanied with disk space narro- wing [7]. Paramarginal syndesmophytes were distinguished from diffuse idiopathic skeletal hyperostosis, which is characterized by bridging of a least four adjacent vertebras, predominant invol- ‘vement of the right side of the thoracic spine, and juvatyiudts ow punoy saqeeENb puny pur puooos oun jo suosuedwio,) “ajhaenb asitj ou) UF uEKA PUODAS Du Ul d1OANs AOU A}ULDLJTUMTIS OSE AIO SUCISE| yoo} pur suoIsa jedsv.9 “apruenb pap ayy Ul LeU ayiuonb yurioy ayy ul s12A9s asou [eo “iBoporpes {0 ALANS 10 “SoRuEYD [OIROJOPEA JO 29 tiauanaa0 Jo oyu “(SOK g°6 1-7-0 SHU!) 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Jeatuejeydodieaejou-\eaSuepeydioqut peunrxosd By Jo SUOISOID YHA woraTINfUOD UL ParIOSqO aa suojSo19 nol eastunyeydaoyut yersiq|“paysoye 242M souls yiog *ase9 JO %4S Uy (| 21g) SILO! pRaFUN| Josinjejauc-peatunyeydiaiul yeuarxord oy) ye put [eaBurpeydodearyaui-jeaduejeydiarus peunxord DYL IB SofDuanbaxy aD|LLIS TIN “(%E'ZR) swianEd ‘OTL wt plinoy a1048 499) 40 spuRY a4 Jo SUOISOH, sinsau jueayjiuR|s parapisuos area. O'O Wey Ssay SoNpPA q 'SISA[EUE VONTIa1I09 oyL Jo} pasn suas ya}o4yj909 ues §,uemsPadS “383p ued pausys suoxoo|iay Suisn payunqeas aia sdnosd paitedun usamiaq saoussayicl 'sdnosBqns usaar Faq SoyqeUA a}NNSIP ZuEdUOD JO} pasn sess 189} qtxo s.lalisty 40 4Sou arenbs-1yp auf “Areayos pump -unjs Suish Pauniopiod o10w sasxjeue [eousHeIS siuopnd uaaas Bulurruras dy) WE uorssnasip saye paysvar spay snsuasuod vb pue ‘susned Eg] Joy S19Asasqo OM) oy) D2 -10q TWOUIDO1Hv a12|dwWOD sex ax9U| |, "2109s DzELLEP 5q) UIEAGO 0} poUTtNs asa Sopesd jenpialpul (BUryw|MUU + ¢ LOIOADS +f :paYLUUL | ¢ ENULJOp EZSyBI|S = | s[eMuOU : Q) 91s uMOd-xI5 w UO Pap “ea sea 199} pue spuey ay) Jo wuLo! jeoaUID|EYdASIUL ysalj pu “Teaguryeyduaiut jewrxosd *eodue/eydos srejeqauu “joaauejeqdodseaeiour yes “AUjetig 'SuON} =roiyipout feutunie peas “[OTG) “12 19 wasie7y a 7 toon ery shoe shinies’ ton U ‘sorren wowed fyaores eaoojope! una “eabunyojeBojpes 19 sauesnase Jo SAC — "A TVA SUIPIRLUV 10d SRL HIOSA XI SSOLLYTINGOD 1K II90 TOA 00 8.6 9 3402, ooo) > .sbeas neva sues tooo toon =3 spe rove ‘toad + pswoxeny sa) ocooa aoe Looog9 > - ‘coaea gioco cra uwretia acon Looe 000 tooo > voaco sees0 —ezor0 olga 4 spueyatouNe oano'> — Jon00% soc0n © so00'0 e000 > oxeo sD $00 eOeD we cone vectos toca t0o0'D Lean © es000 © oom > treo maled.= aera Shera. eo muasO a sujsa.e yo ec apa OMrdls sOUmWIOUN usc “won suo J00u rap suwanes So “snuaqyesod ansuosa i rt u aicos seeoem pue sebum jexSo(pe torsjoq SuONE ION FEV Eglo TACCARI, dnt, and axial changes [2,12] suggested that gender influenced the pattern of joint disease. In our patients who were selected based on the presence of peripheral polyarthritis (with or without axial involvement) the rate of occurrence and severity of peripheral radiological changes were similar in males and females, Patients with axial involvement had more wides- pread and more severe arthritic changes than those without saeroiliitis and/or syndesmophytes Consonant with these findings, mean damage score was significantly higher in patients with than without axial involvement. Earlier studies found that polyarticular disease often indicated more severe psoriatic arthritis [2,12,20], and in our patients additional presence of axial involvement defined a subgroup with more numerous and more severe peripheral radiological lesions. Radiological axial changes were fairly common in our study group. Earlier studies have shown that axial iavol- yement with psoriatic arthritis is sometimes detec- table only by routine radiography [20,23]. Our findings demonstrate that peripheral and axial changes in psoriatic arthritis are not independent. The highest sacroliitis stage score was positively correlated with each arthritic change and with the mean damage score in the overall study population and in those patients with axial involvement. Our resulls are at variance with an earlier study that fa led to detect any correlations between peripheral joint disease paiterns and spinal disease progres- sion in psoriatic spondylarthropathy [23] However, this dissonance may be ascribable t0 di ferences in patient selection criteria and in methods of evaluation. ESTUDIO DE LAS CORRELACIONES ENTRE LOS SIGNOS RADIOLOGICOS DE LA AFECCION AXIAL Y PERIFERICA EN EL CURSO DEL REUMATISMO PSORIASICO En este estudio rerospectiv llevado a cabo en 140 pacientes ‘Meciados de ung for pollatialar de reutatismo! pss Go hemos apalzado ln fecuencia y Wn severidad e las 4n0- fmillas radiologieas del esqueleto periferica y se ha Sorel dn ever de Eon el nel Shar Se ealulado part ead pastes, enero de cto Stones en os pres, maton a severiaad de-aeorcion de has Tfevanyegrado de sao, el ndmeco de iniesmoivos, ETnumero ce entesoparias de Ta pelvis y del calcince el frado J afestclon edilogicasegan el adice de Laren, Las KEsionss radiologic perfericas 5 axial (scroll 2 unilateral 3 vo sindesmoteos) se asoctabn 30 ts" Unieamente 1 renpo de evalu de i enferine- i's corel ionaba con moufcacones ragobicas ean el rato dealscacion de Larsen, Los pacientes fueron separa Go segun in antguedad de Ia enfermedad, et 4 gripes con ieee de pacts Ele de Lae Sgt ‘mente superior en el segunda grupo con celacion a primero {O08)"y en e euaro grupo con relaion al erro (pe Hoots) Pot ef covtzari, ao exists cambion sigatienivos ce 8 sepunto y Sener grupo, Mes QUES LEHR so Uagrevan enlos pemeros anos, afecicion de REVUE DU RHUMATISNE ts JANUARY 1996 SPADARO, Valeria RICCIBRE In our patients, disease duration was positively correlated with the severity of peripheral and, to a lesser extent, axial radiological changes, in kee~ ping with previous findings on outcomes in psoria- tic arthritis patients [19,23-25]. However, the tempos of progression of peripheral and axial changes were markedly different. Damage score values increased rapidly during the first five years following disease onset, then showed no further significant increase until disease duration exe ded ten years, The sacroiliitis seore increase, in contrast, proceeded at a slower pace and was signi- ficant only in the highest disease duration quartile, ‘These findings are in keeping with a large series [20] and a longitudinal study [24] that found early development of both clinical and radiological per~ ipheral lesions in psoriatic arthritis patients, follo- wed by slow progression during follow-up [24] Disease duration was longer in patients with spinal disease [20] Concomitant presence of peripheral and axial lesions may define a subgroup of psoriatic arthritis patients with more frequent and more severe joint lesions that may warrant more ageressive therapy, particularly early in the course of the disease. However, current clinical and radiological criteria used for the classification of psoriatic arthritis patients fail to take into account some of the clini- cal, radiological, and prognostic characteristics of the joint manifestations of this pleomorphic disea- se. Consequently, they should be viewed as a preli- minary approach to psoriatic arthritis subset differentiation in furure studies. UNTERSUCHUNG DER ZUSAMMENHANGE ZWISCTIEN DEN AXIALEN UND PERIPUIEREN VERANDERUNGEN IM ROENTGEN BEI PSORIASIS: ARTHRITIS. ly unserer Studie der Rontgencufnalmen von 140 Patenten, die an einer polyareulren form dee Bsaiasls Aris ten tntersuchten wir die Hautigkeit nd don Schweregrad det Verandcrungen des periphezen Skelots In Verbindung mit diem Schineregrad der Veesaderungen des Axialskoles. Bel sien Fattencn wurde che Anzahl dsr Erosonen an Fen ind Hinden, die Schwere der Handgelenkwverinderungen, das Stavium der Sakroilitis, die Anzahl der Syndesmopter die Aa det Enflesopatnen des Beckens und des Kallanous Sawie dor Roontgon-Seore (Latsen-Methode) berechne. Bel 50 Patenten waten im Reenigen sowell periphere als auch dniale Veranderungen a tchen (bilaterale Sakroilits, Stadium 2 oder unilateral Sakroiitts. Stadium 23, und det Syndesmopisten). 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