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

Scand J Rheumatol. 2017 Nov;46(6):454-460. doi: 10.1080/03009742.2017.1278787. Epub 2017 Feb 10.


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 (33 ± 14 years) and disease onset at a relatively early age (30 ± 12 years). 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 60 years 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.

MeSH terms

  • Activities of Daily Living*
  • Adult
  • Aged
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Psoriatic / complications
  • Arthritis, Psoriatic / drug therapy
  • Arthritis, Psoriatic / physiopathology*
  • Arthritis, Psoriatic / psychology
  • Case-Control Studies
  • Female
  • Humans
  • Joint Deformities, Acquired / etiology
  • Joint Deformities, Acquired / physiopathology*
  • Joint Deformities, Acquired / psychology
  • Logistic Models
  • Male
  • Middle Aged
  • Quality of Life*
  • Retirement
  • Scandinavian and Nordic Countries
  • Self Care
  • Severity of Illness Index
  • Sick Leave
  • Social Participation
  • Sweden


  • Antirheumatic Agents