Dr. Wright realized that a number of inflammatory joint disorders shared clinical features common to PsA: the absence of rheumatoid factor, a predilection for lower-limb oligoarthritis, spinal involvement with sacroiliitis, eye inflammation, and skin disorders resembling psoriasis. He persuaded a succession of bright young doctors to join him in his quest, and these pioneers set about describing the clinical associations that linked inflammatory bowel disease, ankylosing spondylitis, reactive arthritis, Behçet’s disease (then believed to be a member of this group), and PsA. His group also recognized the familial clustering of these diseases (before the discovery of HLA-B27), and they collected a number of impressive family pedigrees.5,6 The culmination of this work, frenetically carried out in a period in the late 1960s and early 1970s, culminated in the monograph Seronegative Polyarthritis, which outlined the evidence for this distinct group of disorders.7 Dr. Wright was extremely proud of this book, co-authored and illustrated by his collaborator, Dr. Moll.
TABLE 1: Historical and Clinical Landmarks in Psoriatic Arthritis
1850–Jean Louis Alibert’s monograph on association between psoriasis and arthritis published
1941–Dr. Bauer presents paper to American Rheumatism Association (ARA) on the association between psoriasis and “rheumatoid arthritis” (RA)
1956–First publication by Dr. Wright on PsA27
1964–ARA recognizes PsA as separate from RA
1973–Landmark paper by Drs. Moll and Wright describes the five subgroups5
1978–Dr. Gladman establishes first cohort of patients in Toronto
1991–Original five subgroups of Drs. Moll and Wright challenged
1998–Dr. McGonagle paper published in Lancet9
2000–First paper describing beneficial effect of anti–tumor necrosis factor drugs in psoriatic arthritis
2003–First meeting of GRAPPA
2006–Publication of classification criteria for psoriatic arthritis (CASPAR)10
2007–Publication of outcomes measures in PsA11
2008–Publication of PsA treatment guidelines12
Following the frenetic efforts of the 1970s, the early 1980s was a relatively quiet period. Dr. Wright had many other interests. He had established a department of world renown, not only in spondyloarthropathy but also in pharmacology, forging early links with large pharmaceutical companies in rehabilitation and bioengineering. His reputation naturally led to a stream of overseas visitors and fellows from diverse disciplines. One fellow from Italy, Antonio Marchesoni, MD, was assigned to review the records in the psoriatic arthritis “register” and to perform a retrospective analysis of cases over the prior 10 to 20 years. The register consisted of a card index file but, sadly, after such a long period, many of the patients had moved on or, in some cases, died. Nevertheless, enough information was available to perform an imaging study that widened the subgroup classification of PsA.8
Advances in PsA in the Post-Wright Era
Shortly after this study, Dr. Wright died and with him, many of his A4 notebooks (famous the world over). Fortunately, when the department finally cleared out of Clarendon Road in Leeds, many of his original research worksheets (what we would now call CRFs) were found, some eaten by mice and some damp, but others well preserved. On review of these worksheets, it was possible to glimpse the painstaking methods carried out in medical research from the 1950s—all the notes were handwritten, recorded neatly in columns, and annotated with comments and asides on clinical features. If that was not enough, all the statistics were calculated manually and noted in meticulous handwriting!
