Background/Purpose: Enthesitis is a common clinical finding and a key pathogenic feature in psoriatic arthritis (PsA). Ultrasound is emerging as a preferred method to assess enthesitis. Little is known about the relation between the presence of enthesitis and the severity of joint damage in patients with PsA. Our aim was to examine the association between sonographic enthesitis and the severity of radiographic features of damage in the peripheral and axial joints.

Methods: A cross-sectional analysis was conducted in patients from a large PsA cohort. The MAdrid Sonography Enthesitis Index (MASEI) scoring system was used to quantify the extent of sonographic entheseal abnormalities in 12 entheseal sites adjacent to large joints. Total MASEI was further categorized into: bone scores (enthesophytes, erosions) and soft tissue scores (structural entheseal changes, vascularization, bursitis). Radiographic joint damage in the peripheral joints and spine was assessed independently of the ultrasound results using the modified Steinbrocker score, Modified New York Criteria for sacroiliitis and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Additionally, the presence of ankylosis, arthritis mutilans and periostitis in the hands or feet was determined. Linear and logistic regression models were used to assess the association between MASEI score and the radiographic features of joint damage after controlling for age, sex, body mass index, PsA duration and the use of DMARDs and biologic medications.

Results:  Two hundred and twenty two patients were included. 58% were males, with mean (s.d.) age of 55.9 (12.9) years and PsA duration of 16.7 (12.4) years. The mean MASEI score was 15.6 (12.6). The mean modified Steinbrocker score was 18.1 (32.3), mSASSS was 1.7 (7.3) and 37% had sacroiliitis. Multivariate regression analyses found an association between higher scores of MASEI scores and peripheral joint damage: modified Steinbrocker score (β 9.26, p<0.0001), joint ankylosis (Odds Ratio (OR) 2.09, p=0.0001) and arthritis mutilans (OR 1.73, p=0.005). The association between MASEI scores and periostitis was of borderline statistical significance (OR 1.29, p=0.06). Similarly, an association was found in multivariate analyses between higher MASEI scores and axial damage as measured by mSASSS (β 1.55, p=<0.0001) and sacroiliitis (OR 1.36, p=0.02). Sub-analysis showed that the MASEI bone score were more strongly associated with radiographic damage outcomes than the MASEI soft tissue score.

Conclusion:  The severity of sonographic enthesitis is a marker of radiographic peripheral and axial joint damage in PsA. The association was found with both destructive and bone formation lesions. These findings highlight the potential role of enthesitis in the pathogenesis of articular damage in PsA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-sonographic-enthesitis-and-radiographic-damage-in-psoriatic-arthritis/