Early psoriatic arthritis: the clinical spectrum.
OBJECTIVE
To characterize the clinical pattern of early psoriatic arthritis (PsA).


METHODS
We studied 47 consecutive patients: 29 had definite PsA and 18 had the "sine psoriasis" subset. Inclusion criteria were articular and/or entheseal involvement of < or =12 weeks' duration and the exclusive use, before enrollment, of nonsteroidal antiinflammatory drugs to control articular symptoms. All patients underwent clinical examination, blood tests, total-body bone scintigraphy, articular ultrasonography, and radiography of clinically involved joints and/or entheses.


RESULTS
On the basis of clinical examination, early PsA was an oligo-enthesoarthritis in over 75% of patients studied. In contrast, the number of joints and/or entheses showing increased tracer uptake on bone scintigraphy was 3 times greater, compared to the clinical evidence (p < 0.001). Articular ultrasonography confirmed the inflammatory involvement of synovium and/or entheses in all articular sites active at time of bone scintigraphy, but silent at clinical examination. In addition, 7 patients showed the occurrence of joint and/or entheseal erosions on standard radiography.


CONCLUSIONS
Bone scintigraphy yields a more accurate evaluation of entheso-articular involvement and distribution in patients with early PsA. Our results suggest that clinical oligo-enthesoarthritic presentation of early PsA might represent in most cases a polyarticular condition that is at increased risk for clinical progression. These findings have a significant influence on the clinical decision-making process in patients with early PsA.
Department of Clinical and Experimental Medicine, Early Psoriatic Arthritis Clinic, Rheumatology Research Unit, University Federico II, Naples, Italy. rscarpa@unina.it
Raffaele
R
Scarpa
Alberto
A
Cuocolo
Rosario
R
Peluso
Mariangela
M
Atteno
Pietro
P
Gisonni
Salvatore
S
Iervolino
Matteo Nicola Dario
MN
Di Minno
Emanuele
E
Nicolai
Marco
M
Salvatore
Antonio
A
del Puente
D000328:Adult; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging*; D008297:Male; D011877:Radionuclide Imaging; D012720:Severity of Illness Index; D014463:Ultrasonography