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Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review
Amir Haddad1, Sindhu R Johnson1, Mansour Somaily1
1From 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.
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%).
Conclusion:
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.
Insights
Psoriatic arthritis mutilans (PAM) lacks classification criteria. This review synthesized clinical and radiographic features from 58 studies, identifying key manifestations like digital telescoping and bone resorption to aid future diagnostic criteria development.
Area of Science:
- Rheumatology and Immunology
- Clinical Diagnostics
- Medical Classification Systems
Background:
- Psoriatic arthritis mutilans (PAM) is the most severe form of psoriatic arthritis.
- Lack of accepted classification criteria hinders research and clinical management of PAM.
Purpose of the Study:
- To systematically review and synthesize clinical and radiographic features associated with PAM definitions.
- To identify key elements for developing future classification criteria for PAM.
Main Methods:
- Systematic literature search of human studies without language restriction.
- Independent screening and data abstraction from 58 articles.
- Collection of clinical and radiographic items, demographics, disease characteristics, and outcomes for PAM patients.
Main Results:
- Identified 8 definitions of PAM used in 283 subjects.
- Prevalent disease manifestations included dactylitis (29-64%) and nail lesions (47%).
- Key clinical features were digital telescoping (34%) and digital shortening (33%); radiographic findings included bone resorption (41%) and ankylosis (21%).
Conclusions:
- Eight definitions of PAM were identified, and associated clinical and radiographic items were synthesized.
- This synthesis provides a foundation for developing standardized classification criteria for PAM.
- Further research can build upon these identified features for improved PAM diagnosis and patient care.
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