Session Type: Abstract Submissions (ACR)
To evaluate the use of musculoskeletal US as a predictor for inflammatory structural progression in psoriatic patients
Measures of association (OR) were tested, in a prospective 1-year follow up study, between structural deterioration and the presence of baseline synovitis, or its persistence. 126 psoriatic patients were prospectively evaluated both clinically and by US (both US-GS and US-PD) at time 0, 6 and 12 months, in order to collect the following variables: 1. 42 joints (2 wrists, 10 MCP, 10 PIP, 10 DIP and 10 MTP) for the presence of synovial hypertrophy and vascularisation (0–3 scale), and the number and dimension of bone erosions; 2. Enthesitis: GUESS (Glasgow Ultrasound Enthesitis Scoring System) index scores was calculated ; 3. Onychopathy. X-ray was carried out at time 0 and at 12 months and lesions were graded using the Sharp/ van der Heijde. Potential prognostic determinants for structural joint damage obtained at the first examination and during follow-up were entered in a conditional logistic regression analysis.
Structural deterioration was observed in 47% of the 5292 evaluated joints in 126 patients. Clinical variables associated with the risk of arthritis in psoriatic patients included: higher BMI (OR 1.7, 95% CI 1:02 to 1:10), percentage of body surface area affected (OR 1.13, 95% CI 1:01 to 1:09), family history of PsA (p <0.001 / OR 5.72, 95% CI 2.79- 91.62). and nail involvement (OR 2.25, 95% 1:36 to 3:41). High BMI was significantly correlated (P < 0.01) with shorter interval of time for the onset of arthritis in psoriatic patients.
Baseline synovial score > 2/ PD score ≥2 increased the risk of structural progression: OR=2.61 (1.26–2.94) p<0.001 versus 1.98 (1.05–2.65) p=0.01 versus 2.66 (1.08–2.76) (P< 0.001) for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of enthesitis was also observed (OR=2.46 (1.15–4.12) (P< 0.01) and 3.50 (1.77–6.95) p<0.001 for US-GS and US-PD and 2.79 (1.05–5.41) P<0.001) for clinical examination. The baseline GUESS scores in psoriatic patients who developed PsA later was significantly higher than those of patients who did not develop joint disease (9.86 ± 2.4 vs. 5.62 ± 2.31, respectively, P< 0.01). Onychopathy was also associated with structural joint damage (OR 2.30, 95%CI 1.17– 3.69). In multiple conditional logistic regression analysis, persistent (vs disappearance) of synovitis/ enthesitis at 6 months of therapy was also predictive of subsequent structural progression.
Identifying predictor risk factors for the development of inflammatory arthritis in psoriatic patients are essential to clinical practice. The presence of US determined synovial thickness, enthesitis and/or onycholopathy associated with positive PD signal at baseline and the persistent PD signal over time have relevant prognostic value for the development of articular damage in psoriatic patients. These results could be an appropriate reference to dermatologists and rheumatologists, and a step forward to tailor the medical management to the patient’s condition.
Y. El Miedany,
M. El Gaafary,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tailored-approach-to-early-psoriatic-arthritis-patients-ultrasonographic-predictors-for-structural-joint-damage/