Bone erosion and psoriatic arthritis

[Fred]

This study looked at bone erosion in patients with psoriatic arthritis.

Quote:

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Objective:
Psoriatic arthritis (PsA) has been recognized as a severe erosive disease. However, some patients do not develop erosions. We aimed to determine the prevalence, characteristics, and predictors of erosion-free patients (EFP) as compared with erosion-present patients (EPP) among patients with PsA followed prospectively.

Methods:
This is a retrospective analysis conducted on patients from the Toronto PsA cohort. Patients with at least 10 years of followup and radiographs were analyzed. Radiographs were scored with the modified Steinbrocker method. Baseline (first visit to clinic) characteristics were used to predict the development of erosions with logistic regression models. To examine the effect of time-varying covariates, Cox regression models were fit for the time to development of erosions from baseline.

Results:
Among 290 patients, 12.4% were EFP and 87.6% were EPP over the study period. The mean time to development of erosion in the EPP over the course of followup was 6.8 ± 6.1 years. EFP were diagnosed with psoriasis at a younger age compared with EPP. In both models, actively inflamed joints and clinically damaged joints were predictive of the development of erosion, whereas a longer duration of psoriasis at baseline decreased the odds of developing erosion. EPP had a higher percentage of unemployment as compared with EFP at baseline and followup visits.

Conclusion:
Among patients with PsA followed for at least 10 years, 12.4% never develop erosions. The clinical and radiographic findings can ultimately assist in the stratification of a patient’s prognosis regarding the development of erosions.

Source: jrheum.org

*Early view funding unknown.

[jiml]

An interesting study it seems that the 12.4% of patients that started the study without erosion to joints,seem to have gone through the study without developing joint erosion. If I'm reading this correctly, and it seems the earlier psoriasis is diagnosed, if in the future you develop PsA you are less likely to suffer joint erosion

Regarding unemployment and PsA its little wonder that people with extremely painful joints also suffered unemployment probably due in a large part to being in some cases disabled and unable to work

[Kit]

I read it too and drew the same conclusions as you Jim. However I am concerned that the study did not have a fixed baseline as such but took the baseline for each patient when they first presented.   So - I think that means each individual had their own baseline?  How does that work? Surely the measurements should be taken against a fixed or even zero baseline?

Mention of the "revised Steinbrocker method" threw me too - I'm going to have to research that as I've no idea what it means.

The conclusion.....    A more accurate prognosis is now possible for some?  
Hmm, was it really worth it? 


Anyway - I've probably read it incorrectly, I'm new at this game and very inexperienced. 
This study is probably far more important than I have been able to deduce. 


Cheers
Kit

[Caroline]

The conclusion.....    A more accurate prognosis is now possible for some?  
Hmm, was it really worth it? 


Anyway - I've probably read it incorrectly, I'm new at this game and very inexperienced. 
This study is probably far more important than I have been able to deduce. 

Some studies really hit the kernel aren't they?

But you will learn.....

[D Foster]

I have PsA but I am sure that I don't have erosion of the joints thank goodness but I have had it for a long time so maybe the statement regarding the longer you are at baseline the less chance of erosion is correct.

[mataribot]

Another study paid for by politicians. Please define PsA properly.

[D Foster]

Another study paid for by politicians. Please define PsA properly.

I don't understand what you mean as it's from The Journal of Rheumatology

The Journal of Rheumatology is a monthly international serial edited by Earl D. Silverman. The Journal features research articles on clinical subjects from scientists working in rheumatology and related fields, as well as proceedings of meetings as supplements to regular issues. Highlights of 41 years serving Rheumatology include: groundbreaking and provocative editorials such as "Inverting the Pyramid," renowned Pediatric Rheumatology, proceedings of OMERACT and the Canadian Rheumatology Association, Cochrane Musculoskeletal Reviews, and supplements on emerging therapies.

[mataribot]

It's well known that the definition PsA is inadequate. I wonder how much of that 12% of subjects don't really have PsA. They have something else or it's just manifestations of Psoriasis.

[mataribot]

Look at this point - the vast majority with PsA have erosion according to this study. Then why do the authors highlight a stat that is for the most part is not significant? Doesn't make sense.g

[D Foster]

It's well known that the definition PsA is inadequate. I wonder how much of that 12% of subjects don't really have PsA. They have something else or it's just manifestations of Psoriasis.

You could also say how many that were diagnosed with EPP did not have PsA but some other type of arthritis , the point is that people with EFP were found to be significant by the fact that they had baseline PsA for at least 10 years and that 6 odd years was the sort of time that it took from a baseline to erosion taking place for the EPPs. The younger that PsA was diagnosed the less likely it would go on to be an EPP situation and the longer duration at baseline with PsA at a younger age decreased the odds of developing erosion .