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Clinical indicators of progression in psoriatic arthritis: multivariate relative risk model
D D Gladman1, V T Farewell, C Nadeau
1University of Toronto Rheumatic Disease Unit, Wellesley Hospital, Toronto, ON, Canada.
Objective:
To identify markers for severe disease in psoriatic arthritis (PsA).
Methods:
Patients with PsA followed prospectively according to a standard protocol over 14 years were included. Clinical and laboratory assessments of both active inflammation and clinical damage were performed at 6-month intervals according to a standard protocol. The information was entered into a computer database. Progression in damage was defined as transitions between damage states based on the number of damaged joints. Both univariate and multivariate models were developed to identify predictors for progression of damage.
Results:
The best model available, based on patient characteristics at the time of being first seen in the psoriatic arthritis clinic suggests that a high number of effusions and of past medications predicts progression in damage, whereas a low sedimentation rate "protects" from such progression.
Conclusions:
Evidence of significant inflammation at first visit predicts progression of damage in the future, suggesting that patients with PsA should be offered more aggressive treatment early in the course of their disease.