title: Swollen joint count in psoriatic arthritis is associated with progressive radiological damage in hands and feet.
abstract: OBJECTIVE
  Psoriatic arthritis (PsA) may progress to joint damage. Determining clinical predictors of joint damage assessed by radiography is important. The aim of this study was to determine clinical factors as possible predictors for radiological damage in hands and feet of PsA patients with a 12-month follow-up.
  
  
  METHODS
  We conducted a retrospective study on 53 PsA patients who were taking disease-modifying anti-rheumatic drugs (DMARDs) and/or tumour necrosis factor (TNF)-alpha-blockers at a fixed dosage. The patients were observed in 118 follow-up visits (intervals of 12 months ± 3 months), according to a clinical and radiological protocol which included the documentation of the number of swollen and tender joints in hands and feet, the applied therapy, psoriasis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and global health assessment. Outcome was defined as radiographic damage of hands and feet (Ratingen score). For the statistical analysis the Chi-Square test for 2x2 crosstables (with Fisher's correction, as required) was used.
  
  
  RESULTS
  Progressive radiological damage was more frequent among patients with an increasing swollen joint count (8 of 26 visits; 30.8%) than among those with a stable or decreased number of swollen joints (5 of 89 visits; 5.6%; p=0.001). The analysis of the patients stratified into the different treatment modalities resulted in a significant higher rate of radiological progress (20.8%) in patients on DMARD therapy compared with TNF-alpha blocking agents (0%) (p=0.009).
  
  
  CONCLUSIONS
  During a 12-month follow-up of PsA patients, an increasing number of swollen joints heralds progression of radiological damage. TNF-alpha-blocker therapy appears to be superior to DMARDs in the protection from radiological progress.
authors.affiliation: Department of Oncology and Rheumatology, Saarland University Medical School, D-66421 Homburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Simon
authors.forename: C
authors.initials: C
authors.lastname: Pfoehler
authors.forename: R
authors.initials: R
authors.lastname: Bergner
authors.forename: M
authors.initials: M
authors.lastname: Schreiber
authors.forename: M
authors.initials: M
authors.lastname: Pfreundschuh
authors.forename: G
authors.initials: G
authors.lastname: Assmann
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000000981:diagnostic imaging* / Q000473:pathology; D006225:Hand / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007596:Joints / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha