Zahi Touma1, Arane Thavaneswaran1, Vinod Chandran1, Fawnda Pellett1, Richard J Cook1, Dafna D Gladman2. 1. From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital. 2. From the Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; A. Thavaneswaran, MMath, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; V. Chandran, MBBS, MD, DM, PhD, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; F. Pellett, BsC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.J. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, FRCPC, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital. dafna.gladman@utoronto.ca.
Abstract
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.
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.