title: Disease activity in and quality of life of patients with psoriatic arthritis mutilans: the Nordic PAM Study.
abstract: OBJECTIVE
  To describe the social status and health-related quality of life of patients with psoriatic arthritis mutilans (PAM) in the Nordic countries.
  
  
  METHODS
  Patients with at least one mutilated joint confirmed by radiology were studied. Disease activity involving joints and skin, physician-assessed disease activity, and patient's education and work status were recorded. Data from the 36-item Short Form Health Survey, Health Assessment Questionnaire and Dermatology Life Quality Index questionnaire were gathered and correlated with disease duration, pain, and general well-being (visual analogue scale). The controls were 58 Swedish patients with long-standing psoriatic arthritis sine PAM.
  
  
  RESULTS
  Sixty-seven patients were included. Patients with PAM had a protracted disease history (33 ± 14 years) and disease onset at a relatively early age (30 ± 12 years). Overall inflammatory activity at inclusion was mild to moderate. The mean number of mutilated joints was 8.2 and gross deformity was found in 16% of patients. Forty per cent were treated with biological and 32% with conventional synthetic disease-modifying anti-rheumatic drugs. Forty-two per cent had retired early or were on sick leave. Impaired functional capacity with little or no ability to perform self-care or everyday tasks was reported by 21% of the patients. Patients between 45 and 60 years of age reported the most impaired quality of life in comparison to the control group.
  
  
  CONCLUSIONS
  PAM seriously affects social functioning. Whether early recognition of PAM and new forms of therapy can improve disease outcome and quality of life remains to be studied.
authors.affiliation: a Department of Medical Sciences , Uppsala University , Uppsala , Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Lindqvist
authors.affiliation: b Centre for Rheumatology Research, University Hospital and Faculty of Medicine , University of Iceland , Reykjavik , Iceland.
authors.forename: B
authors.initials: B
authors.lastname: Gudbjornsson
authors.affiliation: c Department of Dermatology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Iversen
authors.affiliation: d Helsinki Medical Imaging Center , Helsinki University Central Hospital , Helsinki , Finland.
authors.forename: L
authors.initials: L
authors.lastname: Laasonen
authors.affiliation: e Department of Rheumatology , Odense University Hospital , Odense , Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Ejstrup
authors.affiliation: f Department of Dermatology , Stavanger University Hospital , Stavanger , Norway.
authors.forename: T
authors.initials: T
authors.lastname: Ternowitz
authors.affiliation: g Dermatology Unit, Department of Medicine , Karolinska Institutet , Stockholm , Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Ståhle
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012179:Retirement; D012537:Scandinavian and Nordic Countries; D012648:Self Care; D012720:Severity of Illness Index; D018582:Sick Leave; D058992:Social Participation; D013548:Sweden
chemical_list: D018501:Antirheumatic Agents