Session Type: Abstract Submissions (ACR)
Background/Purpose: To compare ultrasound and clinical definitions of remission in psoriasis arthritis (PsA).
Methods: Prospective study of 70 consecutive PsA patients [mean age 51.1 (±SD 11.6) years, 30% female, median disease duration 7.0 (range 0-44.7) years]. Clinical and ultrasound examination was performed at 68 joints and 14 entheses (lateral epicondyle, triceps insertion, quadrizeps insertion, proximal and distal insertion of patellar ligament, Achilles tendon, plantar fascia), and Disease Activity index for PSoriatic Arthritis (DAPSA), composite psoriatic disease activity index (CPDAI), HAQ and PASI were calculated. The following clinical definitions of remission were applied: DAPSA ≤3.3, CPDAI (joint, entheses and dactilytis domains) =0 or a Boolean definition with a score ≤1 in all of the following categories: tender joints (TJ), swollen joints (SJ), CRP, patient’s (PGA) and evaluator´s global assessment (EGA), enthesitis and dactylitis. Sonography was performed by two rheumatologists blinded to clinical data using an ESAOTE Twice ultrasound device. Power Doppler (PD) signals were graded from 0 to 3. The presence of perisynovitis and tenosynovitis was also recorded. Ultrasound remission was defined by a PD-score of 0 at joints, entheses and tendons.
Results: Fifteen (21.4%), 12 (17.1%) and 11 (15.7%) PsA patients were in remission according to the CPDAI, DAPSA and the Boolean definitions. A lower prevalence of PD signals in at least one joint or tendon was found in patients in remission according to DAPSA (58.3% vs. 84.5%, p=0.039 and 8.3% vs. 38.6%,p=0.043, respectively) and the Boolean definition (54.5% vs. 84.7%, p=0.022 and 9.1% vs. 37.9%, p=0.06, respectively) whereas the prevalence of active synovitis was similar in inactive and active disease groups according to CPDAI (66.7% vs. 83.6%, n.s.). Tenosynovitis tended to be more prevalent in cases with active disease according to CPDAI compared to patients in remission (38.9% vs. 13.3%, p=0.06). Frequencies of active enthesitis and perisynovitis were similar in groups with active and inactive disease according to CPDAI, DAPSA and the Boolean definitions.
Three (4.3%) patients had no PD-signal in joints, entheses and tendons. Comparing patients with PD-score=0 [n=14 (20%)] and PD-score≥1 at joints we found a lower number of SJ [0 (0-4) vs. 1 (0-15), p=0.007] and lower ESR [6.5 (1.0-17.0) vs 10.0 (1.0-74.0), p=0.049] among patients with inactive disease. CPDAI, DAPSA, TJ, CRP, PGA; EGA and HAQ were similar in both groups.
Patients without PD-signals at tendons [n=46 (65.7%)] had lower DAPSA [9.9 (0.1 -70.2) vs. 17.4 (0.2 -60.8), p=0.012], lower PGA [30 (0-80) vs. 40 (0-80), p=0.024], lower CRP [2.0 (0-20.3) vs. 4.8 (0.6-49.5), p=0.013] and lower ESR [6.0 (1.0-47.0) vs. 18.0 (5.0-74.0), p<0.001] compared to patients with active tenosynovitis.
Patients without PD signals at entheses [n=27 (38.6%)] did not differ from patients with active disease regarding clinical scores and laboratory measures.
Conclusion: Our data demonstrate a disparity between ultrasound and clinical definitions of remission in PsA. DAPSA and Boolean based definitions of remission are closer to ultrasound defined remission than a CPDAI based definition.
W. B. Graninger,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disparity-between-sonographic-and-clinical-criteria-of-remission-in-psoriasis-arthritis/