Disease activity in and quality of life of patients with psoriatic arthritis mutilans: the Nordic PAM Study

Figures & data

Table 1. Demographics of 67 patients with psoriatic arthritis mutilans (PAM) in comparison to 58 patients with psoriatic arthritis (PsA) sine PAM.

	PAM patients (n = 67)	Reference PsA (n = 58)	p
Gender, female/male, n	33/34	28/30	ns
Age (years)	58 ± 11	56 ± 14	ns
Age at onset of psoriasis (years)	25 ± 15	32 ± 18	< 0.05
Age at onset of PsA (years)	30 ± 12	42 ± 13	< 0.001
Disease duration psoriasis (years)	33 ± 14	21 ± 14	< 0.001
Disease duration PsA(years)	28 ± 12	14 ± 8.2	< 0.001
Treatment at inclusion, n on bDMARD/csDMARD/both	9/24/19	2/29/2	–

Data are shown as mean ± sd unless otherwise indicated.

n, number of individuals; ns, non-significant difference; bDMARD, biological disease-modifying anti-rheumatic drug; csDMARD, conventional systemic disease-modifying anti-rheumatic drug.

Table 2. Disease activity and quality of life in 67 patients with psoriatic arthritis mutilans (PAM) in comparison to 58 patients with psoriatic arthritis (PsA) sine PAM.

	PAM patients (n = 67)	Reference PsA (n = 58)	p
ESR (mm/h)	17.6 ± 18.4	13.9 ± 15.0	ns
CRP (mg/L)	9.1 ± 19.2	12.9 ± 14.2	ns
Assessment of pain VAS (mm)	30.3 ± 26.1	37.3 ± 21.8	ns
Global assessment of disease activity VAS (mm)	33.3 ± 26.0	36.2 ± 22.4	ns
HAQ	0.98 ± 0.81	0.56 ± 0.45	0.001
DLQI	3.7 ± 4.1	nk	–
Morning stiffness (min)	40 ± 43	nk	–
No. of swollen joints (66)	2.0 ± 3.4	3.6 ± 5.0	0.043
No. of tender joints (68)	5.3 ± 9.1	2.6 ± 3.8	0.032
Dactylitis, n (%)	41 (68)	nk	–
PASI	4.5 ± 5.5	6.6 ± 9.0	ns
DAS28	3.4 ± 1.1	3.2 ± 1.1	ns
DAPSA	15.7 ± 15.4	14.8 ± 8.6	ns
Physician’s global assessment of:
Arthritis (mm)	24.3 ± 19.7	nk	–
Skin activity (mm)	17.4 ± 19.7	nk	–
Psoriasis (n)Clear or almost clear/Mild or mild to moderate/Moderate to severe	28/25/10	nk	–
Functional capacity ACR (n)High/Moderate/Low/None	8/35/11/1	nk	–

Data are shown as mean ± sd unless otherwise indicated.

ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; VAS, visual analogue scale; HAQ, Health Assessment Questionnaire; DLQI, Dermatology Quality of Life Index; PASI, Psoriasis Area Severity Index; DAS28, 28-joint Disease Activity Score; DAPSA, Disease Activity in Psoriatic Arthritis; ACR, American College of Rheumatology; ns, non-significant difference; nk, not known.

Figure 1. Need for (A) daily help and (B, C) aids for 67 patients with psoriatic arthritis mutilans. HAQ, Health Assessment Questionnaire.

Figure 2. Absolute values of the 36-item Short Form Health Survey (SF-36) in 67 patients with psoriatic arthritis mutilans (PAM) (blue and red lines), compared with a general healthy population (black lines), separated by gender and differences between the absolute values for a general population and for PAM (green and orange lines). PF, physical function; RP, physical role; BP, bodily pain; GH, general health; VT, vitality; SF, social interactivity; RE, emotional role; MH, mental health.

Table 3. Logistic regression of psoriatic arthritis mutilans patients versus a reference group of psoriatic arthritis (PsA).

Variable		Crude OR (95% CI) p	Model 1 OR (95% CI) p	Model 2 OR (95% CI) p	Model 3 OR (95% CI) p	Model 4 OR (95% CI)p
PsA duration		1.15 (1.09–1.21), < 0.001		1.12 (1.06–1.18), < 0.001	1.14 (1.07–1.21), < 0.001	1.19 (1.11–1.28), < 0.001
Age at onset, arthritis		0.93 (0.90–0.96), < 0.001		0.97 (0.93–1.01), 0.121
Psoriasis duration		1.05 (1.02–1.08), 0.001	1.05 (1.01–1.09), 0.024		1.00 (0.96–1.04), 0.992
Age at onset, psoriasis		0.97 (0.95–1.00), 0.020	1.00 (0.96–1.03), 0.837
MDA score		1.11 (0.89–1.39), 0.351				1.38 (0.95–2.00), 0.091
No. of swollen joints, grouped	1–4 vs 0	0.74 (0.33–1.65), 0.468				1.17 (0.32–4.21), 0.831
No. of swollen joints, grouped	≥ 5 vs 0	0.28 (0.10–0.80), 0.017				0.66 (0.14–3.08), 0.593
No. of tender joints, grouped	1–4 vs 0	0.51 (0.22–1.17), 0.113				0.90 (0.23–3.61), 0.884
No. of tender joints, grouped	≥ 5 vs 0	1.41 (0.56–3.59), 0.466				6.16 (1.21–31.29), 0.028

MDA, minimum disease activity; OR, odds ratio; CI, confidence interval.

Table 4. Logistic regression HAQ_D50 = 1 if Health Assessment Questionnaire (HAQ) score > 1: reference group = 0 and psoriatic arthritis mutilans (PAM) = 1.

Variable	Crude OR (95% CI), p	Multivariable OR (95% CI), p
PAM vs reference	7.57 (2.65–21.65), < 0.001	6.99 (1.63–29.92), 0.009
Global assessment of disease activity VAS	1.04 (1.02–1.06), < 0.001	1.05 (1.01–1.09), 0.026
Assessment of pain VAS	1.03 (1.01–1.04), 0.007	1.00 (0.96–1.04), 0.982
Disease duration PsA	1.06 (1.02–1.10), 0.002	1.02 (0.97–1.08), 0.379
Disease duration psoriasis	1.02 (0.99–1.05), 0.182
No. of tender joints, grouped 1–4 vs 0	1.01 (0.37–2.80), 0.981
No. of tender joints, grouped ≥ 5 vs 0	2.00 (0.70–5.68), 0.193
No. of swollen joints, grouped 1–4 vs 0	1.06 (0.41–2.76), 0.907
No. of swollen joints, grouped ≥ 5 vs 0	1.43 (0.47–4.37), 0.528
ln CRP	1.14 (0.77–1.68), 0.502
ESR	1.04 (1.01–1.07), 0.007	1.03 (0.99–1.07), 0.106

VAS, visual analogue scale; PsA, psoriatic arthritis; ln, logarithmic; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; OR, odds ratio; CI, confidence interval.