title: Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review.
abstract: OBJECTIVE
  Research on psoriatic arthritis mutilans (PAM), the most severe form of psoriatic arthritis, is impeded by the lack of an accepted classification criteria. We performed a systematic review of the literature to identify and synthesize clinical and radiographic features associated with the definition of PAM.
  
  
  METHODS
  A systematic literature search limited to human studies was conducted without language restriction. Abstracts were independently screened by 2 investigators and studies that reported information on patients with PAM were included. A standardized form was used to independently collect clinical and radiographic items defining PAM, patient's demographics, disease characteristics, and outcomes.
  
  
  RESULTS
  There were 8570 citations searched to identify 112 articles for full review and 58 articles for data abstraction. We identified 8 definitions of PAM that were used in 283 subjects with a mean age ± SD at diagnosis of PsA of 33.9 ± 8.2 years. Disease manifestations (prevalence) included dactylitis (29-64%), enthesitis (29-32%), axial disease (14-27%), and nail lesions (47%). PAM definitions include 1 (n = 2 studies) or more (n = 14 studies) joints involving interphalangeal, metacarpophalangeal, or metatarsophalangeal joints. The most prevalent PAM clinical features were digital telescoping (34%), digital shortening (33%), and flail joints (22%). The most prevalent PAM radiographic items were bone resorption (41%), pencil-in-cup change (16%), total joint erosions (14%), ankylosis (21%), and subluxation (7%).
  
  
  CONCLUSIONS
  We have identified 8 definitions of PAM, and synthesized the clinical and radiographic items that are important for the classification of PAM. We have established the groundwork for future development classification criteria for PAM.
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
authors.forename: Amir
authors.initials: A
authors.lastname: Haddad
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
authors.forename: Sindhu R
authors.initials: SR
authors.lastname: Johnson
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
authors.forename: Mansour
authors.initials: M
authors.lastname: Somaily
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
authors.forename: Rouhi
authors.initials: R
authors.lastname: Fazelzad
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
authors.forename: Amie T
authors.initials: AT
authors.lastname: Kron
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
authors.forename: Cathy
authors.initials: C
authors.lastname: Chau
authors.affiliation: From the University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital; Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; University Health Network, Toronto, Ontario, Canada.A. Haddad, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; S.R. Johnson, MD, PhD, Division of Rheumatology, Toronto Western Hospital, and Institute of Health Policy, Management and Evaluation, and Division of Rheumatology, Department of Medicine, University of Toronto; M. Somaily, MD, University of Toronto Psoriatic Arthritis Clinic, Toronto Western Hospital; R. Fazelzad, BSc, MISt, University Health Network; A.T. Kron, BSc (Honors); C. Chau, BMath, CIM, Division of Rheumatology, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, University of Toronto Psoriatic Arthritis Clinic, and Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto. vchandra@uhnresearch.ca.
authors.forename: Vinod
authors.initials: V
authors.lastname: Chandran
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D012720:Severity of Illness Index
keywords: ANKYLOSIS; CLASSIFICATION CRITERIA; OSTEOLYSIS; PSORIASIS; SPONDYLOARTHRITIS