The association between occupational-related mechanical stress and radiographic damage in psoriatic arthritis

doi:10.1016/j.semarthrit.2018.06.001

Seminars in Arthritis and Rheumatism

Volume 48, Issue 4, February 2019, Pages 638-643

https://doi.org/10.1016/j.semarthrit.2018.06.001 Get rights and content

Abstract

Objective

To assess the association between occupational-related mechanical factors and the severity of radiographic peripheral and axial joint damage in patients with longstanding Psoriatic Arthritis (PsA).

Methods

Patients with longstanding PsA (disease duration≥10 years) were identified from a prospective longitudinal cohort. Using an occupation history questionnaire, patients were asked to report all paid employments since the age of 18. The key predictor variables included various occupational-related mechanical exposures. A job classification database was used to rate the level of exposure to various occupational physical activities. The outcomes were the extent of radiographic damage in the peripheral and axial joints, as measured by the modified Steinbrocker score (mSS), and the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS). The association between the predictors and outcome variables was assessed by negative binomial regression models after adjusting for potential confounding variables.

Results

A total of 307 eligible patients were analyzed. In the multivariable analysis, exposure to prolonged repetitive hand movements (exp^(β) 1.17 (95% 1.07, 1.28)) and occupations that required higher level of finger dexterity (exp^(β) 1.27 (95% 1.09, 1.47)) were associated with a higher mSS. With regards to axial damage, none of the occupational exposures or workers abilities was associated with mSASSS.

Conclusion

High level of occupation-related mechanical stress is associated with increased radiographic peripheral joint damage among patients with longstanding PsA. This finding supports the potential role of micro-trauma in the pathogenesis of PsA.

Section snippets

Study population

A cohort analysis was conducted in patients followed in the University of Toronto Psoriatic Arthritis cohort from 1978 to 2016. The cohort includes patients from two academic centres in Toronto, Canada. This cohort was described in detail in the past [14]. In short, patients were referred to the PsA clinics by their family physicians and other medical specialists for the management of their PsA. Patients attending the clinics are enrolled in an ongoing prospective study aimed at assessing

Patient characteristics

A total of 419 patients who fulfilled the study criteria were identified. Of those, 112 patients were excluded for the following reasons: declined participation (n = 51), no history of previous employment (n = 11) and missing radiographs (n = 50). A total of 307 patients who were eligible were analyzed. The patients that were excluded from the study tended to be younger, had shorter disease duration of PsA, higher tender and swollen joint counts and enthesitis at clinic entry.

The demographic

Discussion

The results of our study suggest that occupations involving higher mechanical stress are associated with increased joint damage. Specifically, occupations that involve repetitive hand motions and require finger dexterity were associated with increased peripheral joint damage. These findings support a potential role of biomechanical stress in the context of the synovio-entheseal complex model as a driving mechanism involved in the development of joint damage in PsA.

These results are in

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Psoriatic arthritis (PsA) is a chronic inflammatory disease that often goes unrecognized in patients with psoriasis. As a result, patients may develop significant structural damage before diagnosis and initiation of adequate treatment. Dermatologists are in an unique position to identify early signs and symptoms of PsA. Here, we briefly review the pathogenesis of PsA, differences in PsA presentation within real-world dermatology practice versus rheumatology clinical trials, and imaging modalities that can be used to assess structural damage. We then discuss several ongoing controversies related to prediction, assessment, and treatment of PsA-related structural damage. Debated questions include the following: (1) Does subclinical enthesitis predict progression from psoriasis to PsA?, (2) Does methotrexate inhibit progression of structural damage?, (3) Does structural damage correlate with clinical disease activity?, and (4) Can progression from psoriasis to PsA be prevented? Evidence presented herein suggests that dermatologists, together with rheumatologists, can play important roles in the early diagnosis and treatment of PsA, thereby potentially preventing irreversible structural damage.
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Observed changes in DAS28 are likely due to changes in the number of tender joints and changes in general well-being and pain rather than changes in inflammatory markers (i.e., ESR, CRP)[43,50]. There is some evidence that physically demanding jobs may be associated with more radiographic progression in individuals with PsA and axSpA [47,45]. In PsA, occupations involving higher mechanical stress, especially occupations involving repetitive hand motions and requiring finger dexterity, were found to be associated with increased risk of peripheral joint damage.
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^☆: Grants and financial support: WanLi Zhou was supported by a Summer Studentship Award from the Canadian Association of Psoriasis Patients, Canada. Lihi Eder is supported by a New Investigator Salary Grant from the Arthritis Society and the Canadian Association of Psoriasis Patients. The University of Toronto Psoriatic Arthritis Program is supported by a grant from the Krembil Foundation.

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The association between occupational-related mechanical stress and radiographic damage in psoriatic arthritis☆

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Study population

Patient characteristics

Discussion

Rheum Dis Clin North Am.

Best Pract Res Clin Rheumatol

Psoriatic arthritis

N Engl J Med.

Predictors for clinical outcome in psoriatic arthritis–what have we learned from cohort studies

Expert Rev Clin Immunol

Tumour necrosis factor alpha blockers are more effective than methotrexate in the inhibition of radiographic joint damage progression among patients with psoriatic arthritis

Ann Rheum Dis

The Swedish early psoriatic arthritis registry 5-year followup: substantial radiographic progression mainly in men with high disease activity and development of dactylitis

J Rheumatol

Can traumatic injury trigger psoriatic arthritis? A review of the literature

Clin Rheumatol

Environmental risk factors for the development of psoriatic arthritis: results from a case-control study

Ann Rheum Dis

Association between environmental factors and onset of psoriatic arthritis in patients with psoriasis

Arthritis Care Res (Hoboken)

Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis

Ann Rheum Dis

Enthesitis in psoriatic disease

Dermatology

Microdamage and altered vascularity at the enthesis-bone interface provides an anatomic explanation for bone involvement in the HLA-B27-associated spondylarthritides and allied disorders

Arthritis Rheum

The association between sonographic enthesitis and radiographic damage in psoriatic arthritis

Arthritis Res Ther

Psoriatic arthritis (PSA)–an analysis of 220 patients

Q J Med

Classification criteria for psoriatic arthritis: development of new criteria from a large international study

Arthritis Rheum