natural history and prognosis
Last reviewed 01/2018
Natural history and prognosis
- about a third of patients with psoriatic arthritis have oligoarticular,
non-progressive disease and can be treated symptomatically or with intermittent
intra-articular injections of steroids. However, it is identifying this group
at an early stage that is the crux
- adverse prognostic signs at presentation include:
- polyarticular disease
- previous steroid use (for any reason)
- male sex
- raised inflammatory marker such as the ESR or CRP
- in this larger progressive group joint destruction will occur with time
such that after 10 years significant impact on disability and quality
of life will occur
- in about 5% of people a rapidly advancing and destructive form of
arthritis occurs with the end result being arthritis mutilans
- in about 5% of people a rapidly advancing and destructive form of
arthritis occurs with the end result being arthritis mutilans
- adverse prognostic signs at presentation include:
- mortality is increased in psoriatic disease with an increased prevalence
of the metabolic syndrome and cardiovascular disease
- for this reason identification and treatment of the usual risk factors
for cardiovascular disease (obesity, smoking, hypertension, cholesterol)
is important
- for this reason identification and treatment of the usual risk factors
for cardiovascular disease (obesity, smoking, hypertension, cholesterol)
is important
- people with psoriatic disease are also more likely to have liver abnormailties independent of alcohol use - this makes treatment with traditional agents such as methotrexate problematic, although not impossible
Reference:
- (1) Arthritis Reasearch Campaign (2009). Hands On - Psoriatic arthritis: its presentation and management in primary care.