SAT0712 Evaluation of structural damage in psoriatic arthritis: a systematic literature review
Authors: T. Gudu, I. Janta, R. Ionescu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Measuring structural damage in psoriatic arthritis (PsA) is important since it is the ultimate goal of treatment.<sup>1</sup> Similar to rheumatoid arthritis (RA), structural damage in PsA is evaluated mainly on x-rays, but there is no consensus about the radiologic scoring method to use in trials. Usually scores from RA are used and modified so they can capture PsA specific features, such as distal interphalangeal (DIP) joints involvement, bone proliferation, periostitis, osteolysis etc.<sup>2</sup> <h3>Objectives</h3> The objective of this study was to analyse existing data on the definition and scoring methods of structural damage in studies on PsA. <h3>Methods</h3> A systematic literature review was performed. Studies evaluating structural damage in PsA were identified in Pubmed/Medline and Embase on 10th December 2017. Several synonyms for the main components (i.e. psoriatic arthritis, structural damage, radiologic progression) were used. No search limits were applied. Studies not assessing structural damage or not providing enough information on the definition of damage were not included, nor reviews, case-reports, letters. Descriptive statistics were used. <h3>Results</h3> In all, 3321 abstracts were identified of which 61 full length articles were included in the final analysis. The majority were observational studies (59%). Only 3 studies were on axial PsA (axPsA) and around 10% of the studies also had a control population, e.g., RA, osteoarthritis, spondyloarthritis and healthy individuals. In total, a median of 220 (minimum-maximum: 12–1077) patients were included. Most of the studies used the CASPAR criteria (63.9%). A wide majority of studies (80.3%) assessed progression of structural damage. Structural damage was defined mainly radiographically (77%), followed by the clinical definition (24.6%) and to a lesser extent by other investigations: magnetic resonance imaging (8.2%), computer tomography (4.9%) and ultrasound (3.3%), respectively. Radiologic assessment of peripheral damage included radiographs of hands and feet, but was very heterogeneous, with most of the studies using the scores "borrowed" from RA and modified for PsA. Hence, 97.8% of the studies using the radiographic evaluation of damage have adapted the scoring method so that it includes the DIP joints of hands and feet. The following elements were included in the radiographic scores: space narrowing 42 studies (93.3%), erosions 44 (97.8%), osteolysis 24 (53.3%), proliferation 12 (26.7%), periostitis 9 (20%), tuft resorption 14 (31.1%), pencil in cup 17 (37.8%), juxta-articular osteopenia/osteoporosis 4 (8.9%), subluxation 6 (13.3%), and ankylosis 5 (11.1%) (table 1). In axPsA radiographic damage was defined by sacroiliitis grades and spine damage, i.e., presence of syndesmophytes and scores such as BASRI-spine, mSASSS, RASSS and PASRI. <h3>Conclusions</h3> Damage in PsA is usually evaluated radiologically. Although radiographic scores are almost always adapted for PsA in order to include DIP joints, the other PsA specific radiographic elements are not so frequently assessed. A more specific but also a feasible radiographic score for PsA damage to be universally used in studies is still needed. Further research on other methods of evaluating PsA damage is also needed since data is scarce. <h3>References</h3> [1] Gossec, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis Ann Rheum Dis2016;75:499–510. [2] Wassenberg S. 2015;33:S55–9. <h3>Disclosure of Interest</h3> None declared