Background/Purpose: Enthesitis is one of the hallmarks of psoriatic arthritis (PsA) and may be the initial site of musculoskeletal inflammation. Enthesitis affects up to 50 % of patients with PsA and is a marker of more severe disease. However, clinical evaluation of enthesitis may be difficult. Ultrasound (US) is more sensitive than physical examination in detecting enthesitis. In patients with psoriasis alone (PsC) US can detect subclinical enthesitis which may predict future development of PsA. The aim of this study was to assess the association between the severity of sonographic enthesitis and risk factors for developing PsA. These risk factors include included obesity, severity of psoriasis, nail psoriasis in addition to physically demanding occupation and the presence musculoskeletal symptoms.

Methods: A cross-sectional study was conducted in patients with a dermatologist confirmed diagnosis of psoriasis. Each patient was assessed by a rheumatologist to exclude the presence of PsA. Information was collected about lifestyle habits, medical history, musculoskeletal symptoms and the skin activity using validated measures. The Madrid Sonography Enthesitis Index (MASEI) was used to quantify the severity of enthesitis in 12 entheseal sites. The sonographer was blinded to the clinical data. MASEI score³20 was considered as high score based on a previously validated cut-off in spondyloarthritis. Logistic regression analysis was used to assess the association between PsA-related risk factors and high MASEI score after adjusting for age, sex and BMI. The results were expressed as odds ratio (OR) and their 95 confident interval (CI).

Results: A total of 180 patients were studied. Of those, 52% were male with a mean age of 51.1±13.6 yrs. Majority of the patients (97%) didnÕt have tender entheseal site on the examination. The mean total MASEI score was 9.3±8.3 and high MASEI (³20) was found in 17 (9.4%) of the patients. The results of the regression analysis are shown in Table 1. Univariate regression analyses found an association between high MASEI score and Health Assessment Questionnaire (HAQ) (OR_14.8; P 0.006), the presence of morning stiffness (OR_=_ 4.7; P 0.009) physically demanding occupation (OR_=_ 5.5; P 0.01). The multivariable analysis showed that the presence of inflammatory back pain (OR 22.9, 95% CI 1.3, 401.8), morning stiffness (OR 5, 95% CI 1.03, 24.3), physically demanding occupation (OR 5.1, 1.01, 25.8) and HAQ (OR 13.9, 95% CI 1.02, 190.5) were associated with high MASEI.

Conclusion: In PsC patients, the severity of subclinical enthesitis was associated with occupational related physical stress and with inflammatory musculoskeletal complaints. Enthesitis might be playing a role in explaining the patients MSK complains in the absence of clinical features of PsA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-sonographic-enthesitis-in-patients-with-psoriasis-without-arthritis-and-its-association-risk-factors-of-psoriatic-arthritis/