Psoriatic polyarthritis of the elderly: radiological assessment

The authors examined retrospectively 157 patients with psoriatic polyarthritis and found in 9 cases (5.7%) a late onset (≤60 yrs) of the articular involvement. The radiological features of these patients were compared with those of 32 subjects presenting an earlier onset (20-45 yrs) but a comparable disease duration, to point out any relevant differences due to the age of onset. The late onset psoriatic arthritis is characterized by a more frequent involvement of DIP (p < 0.01) and PIP-MCP (p < 0.04) joints. In patients with late onset polyarthritis the mean number of DIP (p < 0.01), PIP-MCP (p < 0.004) and DIP-PIP-MCP (p < 0.01) joint erosions, the mean degree of carpal involvement (p < 0.04) and the number of proximal limb joints with radiological lesions (p < 0.03) are significantly higher. Moreover 44% of elderly onset patients have a severe radiological axial involvement. The evidence of severe radiological joint lesions in late onset psoriatic polyarthritis suggests that a careful radiological assessment is required for a better prognostic and therapeutic evaluation of the disease.