Classification and Epidemiology

The first classification criteria for PsA were proposed in 1973 by Moll and Wright (1973) defining an inflammatory arthropathy in patients with psoriasis, usually with negative rheumatoid factor, and five distinct clinical subsets: (1) oligoarticular (<5 tender and swollen joints) asymmetric arthritis, (2) polyarticular arthritis, (3) distal interphalangeal joint (DIP) predominant, (4) spondylitis predominant, and (5) arthritis mutilans. Although several classification criteria for PsA have been proposed since the initial Moll and Wright criteria (Helliwell and Taylor 2005; Taylor et al. 2004), the Classification of Psoriatic Arthritis study group (CASPAR) has conducted an authoritative international study and has developed new classification criteria for PsA, in order to improve classification sensitivity and specificity, the results of which are soon to be published (Taylor et al. 2005; Taylor 2006) (Table 10.2, p. 106). Partly because of relatively recent recognition as a discrete disease entity, as well as the heterogeneity of clinical presentation, diagnostic confusion with other diseases in the differential diagnosis, and chance of subclinical arthritis not yet symptomatic in a patient with psoriasis (Offidani et al. 1998), it is likely that the disease has historically not always been accurately identified. With these limitations in mind, it is known that psoriasis affects approximately 2 - 3 % of the general population and the prevalence of PsA in psoriasis patients is reported as being from 6% to 39% (Leonard et al. 1978; Shbeeb et al. 2000). Telephone surveys recently conducted in Europe and in the US, respectively, suggest a prevalence of 30% (Salonen 2003) and 11 % (Gelfand et al. 2005). This wide range is related to the heterogeneity of the populations studied, as well as to differing methods of ascertainment. In any case, it is clear that there is a distinctive inflammatory arthritis (with varied patterns of presentation) associated with psoriasis (Glad-man et al. 2005).

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