Disease activity in and quality of life of patients with psoriatic arthritis mutilans : the Nordic PAM Study

Objective: To describe the social status and health-related quality of life of patients with psoriatic arthritis mutilans (PAM) in the Nordic countries.Method: Patients with at least one mutilated joint confirmed by radiology were studied. Disease activity involving joints and skin, physician-assessed disease activity, and patient's education and work status were recorded. Data from the 36-item Short Form Health Survey, Health Assessment Questionnaire and Dermatology Life Quality Index questionnaire were gathered and correlated with disease duration, pain, and general well-being (visual analogue scale). The controls were 58 Swedish patients with long-standing psoriatic arthritis sine PAM.Results: Sixty-seven patients were included. Patients with PAM had a protracted disease history (3314years) and disease onset at a relatively early age (30 +/- 12years). Overall inflammatory activity at inclusion was mild to moderate. The mean number of mutilated joints was 8.2 and gross deformity was found in 16% of patients. Forty per cent were treated with biological and 32% with conventional synthetic disease-modifying anti-rheumatic drugs. Forty-two per cent had retired early or were on sick leave. Impaired functional capacity with little or no ability to perform self-care or everyday tasks was reported by 21% of the patients. Patients between 45 and 60years of age reported the most impaired quality of life in comparison to the control group.Conclusion: PAM seriously affects social functioning. Whether early recognition of PAM and new forms of therapy can improve disease outcome and quality of life remains to be studied.Peer reviewe

Dimitri Rostoff as Francesca's Husband Gianciotto Malastesta (far left), Lubov Tchernicheva as Francesca (second from left), Vera Nelidova as Francesca's Nurse Chiara (sixth from left), Edouard Borovansky as Malatesta's Spy Girolamo (crouching below halberd on right), and artists of the company, in Francesca da Rimini, The Original Ballet Russe, Australian tour, His Majesty's Theatre, Melbourne, 1940 [picture] /

From: Francesca da Rimini : choreographic drama in two scenes / by David Lichine and Henry Clifford, partly drawn from Dante ; music by Peter Ilich Tchaikovsky.; Inscription: "3P/20".; Part of the collection: Hugh P. Hall collection of photographs, 1938-1940.; Performed March and April 1940.; Choreography by David Lichine ; scenery and costumes by Oliver Messel ; scenery executed by Prince A. Schervachidze ; costumes executed by B. Karinska.; Also available in an electronic version via the internet at: http://nla.gov.au/nla.pic-vn4103370. One of a collection of photographs taken by Hugh P. Hall of 28 ballet productions performed by the Covent Garden Russian Ballet (toured Australia 1938-1939) and the Original Ballet Russe (toured Australia 1939-1940). These are the second and third of the three Ballets Russes companies which toured Australasia between 1936 and 1940. The photographs were taken from the auditorium during a live performance in His Majesty's Theatre, Melbourne and mounted on cardboard for display purposes. For conservation and storage, the photographs have been demounted. The original arrangement of the photographs has been recorded, and details are available from the Pictures Branch of the National Library