entheses easily accessible to clinical examination. This included entheses known to be involved in AS together with sites of possible involvement. The following sites were examined: the nuchal crests, the manubriosternal joint, the costochondral joints, the greater tuberosity and the medial and lateral epicondyles of the humerus, the iliac crests and the anterior superior iliac spines, the greater trochanter of the femur, the tibial tuberosities, the adductor tubercles, the medial and lateral condyles of the femur and tibia, the head of the fibula, the calcaneal insertions of the plantar fascia and the achilles tendons, the sacroiliac joints, the cervical, thoracic, and lumbar spinous processes, the ischial tuberosities, and the anterior posterior iliac spines.A scoring system was developed based on the patients' response to firm palpation over these entheses. Some of the sites were scored individually, whereas others were scored as a group, the highest scoring site being recorded for the group as a whole. The sites which were grouped in this way were: the nuchal crests, the costochondral joints, the sacroiliac joints, and the cervical, thoracic, and lumbar spinous processes. The remaining sites were scored individually left and right.

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The concordance for psoriasis is greater than for PsA, but the concordance rate for PsA was similar to that in HLA identical siblings with rheumatoid arthritis. There was discordance in pattern of arthritis for most sib pairs. There is no support for the use of more complex classifications of PsA.

We have used the Health Assessment Questionnaire (HAQ) to follow changes in disability in an unselected group of 245 patients with RA. The HAQ has been widely used in cross-sectional studies of disability in RA, but little is known about the dynamics of the change in HAQ score with long term follow-up. If it is to prove useful as a measure of health outcome it must not only be able to accommodate a wide range of disability but also show adequate sensitivity to change in disability. We administered the HAQ to 245 RA inpatients and outpatients at the beginning and end of a 5-yr period to address this important question. The mean change in individual HAQ score in the 175 patients for whom complete data was available was +0.18 (SD 0.66) over 5 yr, i.e. 0.03 units per year. It is likely that the observed rate of change in HAQ score is an under-estimate of the true rate of progression of disability, as the scale failed to accommodate change in disability toward its upper limit. The inherent design of the HAQ creates several 'ceilings' in functional subcategories (such as lower limb function) which may be masked by the overall HAQ score. Longitudinal studies of disability using the HAQ as outcome measure should therefore be interpreted with caution, and close attention paid to the baseline HAQ score.

No abstract