Background/Purpose:

Psoriatic Arthritis Mutilans (PAM) is the most severe form of psoriatic arthritis. Research on PAM has been impeded by the lack of an accepted definition. We performed a systematic review of the literature to identify clinical and radiographic features associated with the definition and manifestations of PAM.

Methods:

Medline, Embase, Cochrane Central Register for Controlled trials, Cochrane databases of Systematic Reviews and CINAHL databases from 1946 until March 2013, were searched without language restriction but limited to humans studies. Two investigators independently screened titles and abstracts and included studies that reported information on patients with PAM with clinical or radiographic information. The selected articles were retrieved for extraction of the data. Machine translation software was used to translate articles to English. Two investigators independently used a standardized form to collect items mentioned in the definition of PAM including the presence of shortening of digits, digital telescoping, flail joints, number and type of joints affected, time to joint destruction, the presence of total erosions at both sides of the joint, bone resorption, pencil-in-cup change, ankylosis, and subluxation. Patients demographics, disease characteristics, clinical and radiographic outcomes were also recorded.

Results:

8145 citations were identified of whom 7080 were excluded as they were not related to the topic, 68 were on patients with other rheumatic diseases, 82 had missing or different outcomes and 866 were duplicates. Of the 103 articles selected for full review, 49 were eligible for data abstraction and included 17 review articles, 13 case studies, 12 cohort studies, 6 case series, 2 case-control and 2 cross sectional studies. The most commonly used definition was that by Moll and Wright[i] (78%). The clinical features that were mentioned in the definitions included shortening of digits (38%), presence of digital telescoping (36%) and flail joints (15%). Only 21% of the articles specified the type of joints affected and few commented on time to joint destruction. The radiographic items that were mentioned in the definition included the presence of bone resorption (45%), pencil-in-cup change (17%), ankylosis (21%), total joint erosion (13%) and subluxation (9%). The studies reported a total of 244 patients. Based on data availability, 49% were males and had a mean age of 44.7 ± 14.7 years, most of the cases had psoriasis before the diagnosis of arthritis with a mean age of psoriasis diagnosis at 25.6 ± 6 years and psoriatic arthritis at 30.9 ± 6.7 years. They had invariably one or more of the aforementioned clinical and radiographic features that affected one or more of the small joints in hands and feet within different time intervals.