Background Psoriatic arthritis (PsA) disease duration and severity of joint inflammation significantly affect the radiographic outcome which can be used as a prognostic factor for PsA progression.
Objectives To describe the radiographic changes in early PsA (EPsA), defined as <2 years since symptom onset.
Methods EPsA patients were assessed at a rheumatology clinic specializing in PsA. Standard clinical and laboratory assessments, including conventional radiography of peripheral (hands, wrists and feet) and sacroiliac joints were conducted. Radiographic changes were classified as normal, abnormal-not clinically relevant, and abnormal-clinically relevant.
Results A total of 81 patients with EPsA (mean (SD) disease duration =1.0 (0.8) years) were included in this analysis.
The most common joint involvement was polyarticular (60.5% of patients) presentation (symmetric or asymmetric) and Distal Interphalangeal Predominant (DIP) involvement (56.8% of patients). Among the 81 patients, radiographic damage (clinically relevant) was identified in 23 (28.4%) patients, of whom 9 (39.1%) had changes in 2 joints and 7 (30.4%) in ≥3 joints. The vast majority of these patients (73.9%) experienced joint damage within the 1st year of symptoms. The observed radiographic changes included new bone formation (often interpreted by radiologists as degenerative), slight-to-moderate narrowing of the joint space, and marginal and central bone erosions. Overall, 14 (17.3%) patients had clinically relevant abnormalities in hands (10 (71.4%) in both hands), 11 (13.6%) in feet (9 (81.8%) in both legs), 4 (4.9%) in sacroiliac joints, and 1 (1.2%) in wrists.
Follow-up (12-18 months) information was available for 68 patients. Among these, 7 (10.3%) patients displayed radiographic progression and 61 (89.7%) remained stable. Radiographic progression included worsening of joint erosion and space narrowing in patients with [2 (28.6%)] or without [5 (71.4%)] prior clinically relevant abnormalities.
Conclusions Radiographic damage was detected in 28% of EPsA patients, the vast majority of whom acquired the damage as early as the 1st year of symptom onset. The increased incidence of axial and DIP joint involvement are in agreement with previous studies showing that they represent the most common sites in PsA. Radiographic progression was only observed in 10% of patients highlighting the importance of early PsA diagnosis and intervention.
Disclosure of Interest None Declared