Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Analysis of Radiographic Changes in Patients with Early Psoriatic Arthritis.

Khraishi1,  Majed M., Aslanov2,  Rana, Rampakakis3,  Emmanouil, Duong4,  Anh, Sampalis3,  John S.

Memorial University of Newfoundland, St Johns, NF
Memorial University of Newfoundland, St.John's, NF
McGill University & JSS Medical Research, Montreal, QC
JSS Medical Research, Westmount, QC


Psoriatic arthritis (PsA) is a seronegative arthropathy characterized by axial involvement, peripheral arthritis, and enthesitis. Disease duration and severity of joint inflammation significantly affect the radiographic outcome which can be used as a prognostic factor for PsA progression. Radiography at early PsA (EPsA) stages can play a vital role in the patient evaluation, differential diagnosis from other arthritis types and management. The aim of this study was to describe the radiographic changes in EPsA, defined as <2 years since symptom onset


EPsA patients (pts) were assessed at a rheumatology clinic specializing in PsA. Standard clinical and laboratory assessments including conventional radiography of peripheral (hands, wrists and feet) and sacroiliac joints were conducted at baseline. All detected radiographic changes were classified as normal, abnormal-not clinically relevant-, and abnormal-clinically relevant-, and their association with patient demographics and baseline characteristics was analyzed


A total of 84 pts with EPsA (mean (SD) disease duration = 1.0 (0.8) yrs) were included in this analysis. Table 1 shows the cohort baseline characteristics. The most common joint involvement was polyarticular (59.5% of pts) presentation (symmetric or asymmetric) and Distal Interphalangeal Predominant (DIP) involvement (57.1% of pts).

Among the 79 pts with available baseline radiological assessment until now, radiological damage was identified in 25 (31.6%) pts, of whom 10 (40%) had changes in 2 joints and 3 (12%) in >=3 joints. The vast majority of these pts (n=19, 76%) experienced joint damage within the 1st year of PsA onset. The observed radiographic changes included new bone formation (often interpreted by radiologists as degenerative), slight to moderate narrowing of the joint space, and marginal and central bone erosions, with the majority of abnormalities appearing in the hands, feet and sacroiliac (SI) joints. Among the 66 pts evaluated, 15 (23%) had abnormal hand images, of whom 9 (60%) in both hands. Furthermore, 10% of the evaluated pts (5/50) had radiographic abnormalities in feet (3 (60%) in both legs) and 10.4% (7/67) in SI joints (2 (30%) in both sides).

Mean (SD) CRP was higher in pts with radiological damage compared to the rest of the cohort (8.8 (7.7) vs 5.8 (5.5);P=0.053). Mean (SD) SJC was also higher in former pts (4.4 (6.2) vs 3.0 (3.7)), although without reaching statistical significance. All other parameters were comparable between the groups


Radiological damage was detected in 32% of patients with EPsA, which was associated with increased CRP. Among these, 76% acquired the damage within the 1st year of symptom onset. Asymmetric oligoarthritis was not a dominant pattern in our cohort as was previously reported. The increased incidence of axial and DIP joint involvement are in agreement with previous studies showing that they represent the most common sites in PsA.

Table 1. Baseline Characteristics and Patient Disposition

Mean (SD) Age (years)48.04 (10.55)
Female Gender: n (%)44 (52.4%)
Mean (SD) Age at PSO Diagnosis (years)38.73 (14.17)
Mean (SD) Age at PsA Diagnosis (years)47.85 (10.66)
Mean (SD) PASQ score11.33 (4.83)
Mean (SD) PASI score3.51 (5.94)
Mean (SD) CRP6.71 (6.36)
Mean (SD) ESR15.99 (18.43)
Mean (SD) TJC8.32 (8.48)
Mean (SD) SJC3.42 (4.60)
PsA Treatment n (%) 
  NSAIDs68 (81.0)
  MTX26 (31.0)
  Sulfasalazine9 (10.7)
  Anti-TNFá8 (9.5)

To cite this abstract, please use the following information:
Khraishi, Majed M., Aslanov, Rana, Rampakakis, Emmanouil, Duong, Anh, Sampalis, John S.; Analysis of Radiographic Changes in Patients with Early Psoriatic Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1548

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