Background/Purpose: Early diagnosis in psoriatic arthritis (PsA) is mandatory in order to initiate early therapy and prevent disability. Around 20% of patients with Psoriasis (PsO) routinely visited in Dermatology departments have PsA previously undiagnosed. The aim of this study is to evaluate the presence of inflammation by clinical examination and ultrasound in joints and enthesis of patients with PsO without musculoskeletal symptoms.

Methods: Patients with PsO under topic or PUVA therapy without musculoskeletal symptoms were referred to our Arhritis Unit. Clinical and demographic data were collected. The patients were evaluated for Body Surface Area (BSA), Swollen Joint Count (SJC) (66 joints), Tender Joint Count (TJC) (68 joints) and enthesis (MASES). Psoriatic Arthritis Impact of Disease tool questionnaire (PsAID) and Psoriasis Epidemiology Screening tool questionnaire (PEST) were used to assess the impact of the disease. A comprehensive ultrasound evaluation of 46 joints and 12 enthesis was made (ESAOTE MylabTwice, 12-18 Mhz probe). Enthesis score was calculated using the Madrid Sonographic Enthesis Index (MASEI) and a total score for synovitis (synovial hypertrophy and Power Doppler) was also calculated.

Results: 32 patients were included. 18 patients were female (56.3%), mean age (SD) was 48.3 years (14.6) and disease duration was 17.9 years (15.9). Mean BMI was 24.6 (5.2) and BSA 6.69 (8.7). 8 out of 32 (25%) had severe PsO (systemic treatment or BSA>10% at any time of evolution). 4 patients (12.5%) had Power Doppler signal and 2 (6.3%) fulfilled criteria for ultrasound-defined active synovitis (SH>2+PD) despite no signs or symptoms of musculoskeletal disease. However, although structural alterations such as calcifications and enthesophytes were frequent, no PD was found at any enthesis. In the univariate analysis, higher BMI (p=0.013), weight (p=0.010), waist (p=0.033) and hip (p=0.014) circumferences were significantly associated with severe PsO. In the same way, CRP serum levels were also significantly higher in patients with severe PsO (p=0.027).

Conclusion: Patients with severe PsO had significantly higher CRP serum levels, BMI, weight, waist and hip circumferences. Of note, 12.5% of PsO patients had subclinical synovitis defined as PD. These patients should be followed in order to confirm if they develop Psoriatic Arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-and-sonographic-analysis-of-patients-with-psoriasis-without-musculoskeletal-complaints-preeliminary-results-of-a-prospective-study-the-pre-psa-cohort/