Epidemiological and clinical characteristics of psoriatic arthritis in northern Norway.
BACKGROUND
To determine the characteristics of psoriatic arthritis (PsA) in northern Norway, where the human leucocyte antigen HLA-B27 is prevalent.


METHODS
An observational study of patients with ICD-9 CR codes for psoriatic arthropathy (696.0 and 713.3) and spondylarthritis (720) seen during a 19-year period at a single regional rheumatology department. In patients with confirmed PsA demographics, date of onset of arthritis and psoriasis, clinical presentation and subsequent disease course (including therapeutic measures) were recorded during a mean follow-up of 11.1 years.


RESULTS
Arthritis was documented in 329/657 (50%) of patients with a diagnostic code for PsA. The mean annual incidence rate for PsA was 6.9/100 000 and the point prevalence was 130/100 000 (0.13%) adults. The male to female ratio was 1.4 and the mean age at onset of psoriasis was 27.8 years (SD 14.1), and 35 years (SD 11.8) at onset of arthritis. Arthritis preceded psoriasis in 13.8% of cases. Oligoarthritis was the most frequent subtype (48%), followed by polyarthritis (32%), spondylitis (9%), monoarthritis (7%), and classic distal interphalangeal (DIP) arthritis (2%). Erosive disease (56% of cases) occurred mainly with polyarthritis; arthritis mutilans occurred in six patients (2%). Surgical interventions were performed in 22% of patients. Disease activity fluctuated considerably over time. Mortality (4.3%) was increased in PsA patients with polyarthritis and secondary amyloidosis (n = 5).


CONCLUSIONS
The prevalence of PsA and related spondylitis is not increased in northern Norway. PsA does, however, lead to a considerable burden of disease due to erosive disease development and surgical intervention.
Nossent
J C
JC
Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø and University Hospital North Norway, Tromsø, Norway. hans.nossent@unn.no
Gran
J T
JT
D000328:Adult; D017677:Age Distribution; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D015796:HLA-B27 Antigen / Q000032:analysis / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D016012:Poisson Distribution; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D018709:Statistics, Nonparametric
D018501:Antirheumatic Agents; D015796:HLA-B27 Antigen; D008727:Methotrexate