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Abstract Number: 0315

The Role of Ultrasound for the Assessment of Psoriatic Arthritis Patients with Fibromyalgia

Ari Polachek1, Victoria Furer2, Mirna Zureik3, Sharon Nevo3, Liran Mendel4, David Levartovsky2, Jonathan Wollman3, Valerie Aloush2, Mark Berman2, Ilana Kaufman5, Reut Tzemach4, Marina Anouk6, Ofir Elalouf7, Hagit Padova4, Or Carmi8, Tali Eviatar9, Yael Lahat goldstein2, Hagit Sarbagil-Maman10, Sara Borok Lev-Ran2, Adi Broide3, Lihi Eder11, Daphna Paran2 and Ori Elkayam3, 1Tel Aviv Sourasky Medical Center, Petah-Tikva, Israel, 2Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, 3Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel, 4Souraaky Medical Center, Tel-Aviv, Israel, 5Tel Aviv Sourasky Medical Center, Petah-Tiqwa, Israel, 6Souraaky Medical Center, Tel Aviv, Israel, 7Souraaky Medical Center, Herzliya, Israel, 8Souraaky Medical Center, herzelia, Israel, 9Tel Aviv Sourasky Medical Center, Givataim, Israel, 10Tel-Aviv Sourasky Medical Center, Kiryat Ono, Israel, 11University of Toronto, Toronto, ON, Canada

Meeting: ACR Convergence 2020

Keywords: Disease Activity, fibromyalgia, Psoriatic arthritis, Ultrasound

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Session Information

Date: Friday, November 6, 2020

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster I: Psoriatic Arthritis

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The presence of fibromyalgia (FMS) in psoriatic arthritis (PsA) patients increases the scores of the clinical measures of disease activity.

The aim of this study is to examine whether ultrasound (US) can be used in the evaluation of disease activity in PsA patients with concomittant FMS as an objective tool that is not influenced by the presence of FMS

Methods: The study population included consecutive PsA patients that were recruited prospectively and fulfilled the CASPAR criteria. The assessment of the patients included, complete medical history and physical examination including assessment of joints (66/68 joint count), enthesitis (LEEDS and SPARCC), and fibromyalgia tender points. All the patients were assessed by the widespread pain index (WPI) and symptom severity score (SSS) for fibromyalgia criteria. Patients were classified with FMS if they fulfilled the 2016 fibromyalgia classification criteria. All the patients underwent a detailed US evaluation (gray scale and Doppler) including 52 joints, 40 tendons and 14 points of entheses (according to MASES index plus lateral epicondyles). The score of the US was based on the summation of a semi-quantitative score (0-3) for synovitis (based on the EULAR-OMERACT definition), tenosynovitis, and enthesitis score. All the evaluations occurred in the same day and the sonographer was blinded to the clinical data. 

Results: 156 patients completed the study. Overall 7540 joints, 5800 tendons and 2030 entheses were scanned by the US. 42 patients (26.9%) classified with both PsA and FMS were compared to 114 (73.1%) PsA patients without FMS. Patients with PsA and FMS had significantly increased scores for almost all the clinical measures, including non-MDA (97.6% vs. 54.4%, p< 0.001), mean CPDAI (11.6 vs. 6.8, p< 0.001), mean DAPSA (35.1 vs. 15.9, p< 0.001) and mean PASDAS (5.8 VS. 2.7, P< 0.001). On the other hand, the total US score and its’ subcategories (US synovitis, tenosynovitis and enthesitis) did not demonstrate significant differences between those with to those without FMS (Table 1). The US score significantly correlated with each clinical score (CPDAI, DAPSA and PASDAS, p< 0.01) in the PsA without FMS but not in the PsA and FMS group (Table 2). Furthermore, these correlations were significantly higher for the CPDAI and PASDAS in the PsA without FMS compared to PsA with FMS (p< 0.05). Multivariable linear regression model showed that FMS was significantly associated with higher clinical scores (p< 0.001) but not with the US score (Table 3).

Conclusion:

Patients with PsA and FMS had increased scores of clinical measures compared to those without FMS. US scores were similar between the groups, independently of the presence of FMS. Hence, US has a significant additional value over composite clinical scores in the assessment of disease activity in PsA patients with fibromyalgia.

Table 1: Sonographic comparison between PsA without and with fibromyalgia

Table 2: Correlations of US score with Clinical scores in PsA with and without Fibromyalgia

Table 3: Multivariable linear regression model for association with clinical scores (DAPSA, CPDAI, PASDAS) & Total US score


Disclosure: A. Polachek, None; V. Furer, None; M. Zureik, None; S. Nevo, None; L. Mendel, None; D. Levartovsky, None; J. Wollman, None; V. Aloush, None; M. Berman, None; I. Kaufman, None; R. Tzemach, None; M. Anouk, None; O. Elalouf, None; H. Padova, None; O. Carmi, None; T. Eviatar, None; Y. Lahat goldstein, None; H. Sarbagil-Maman, None; S. Borok Lev-Ran, None; A. Broide, None; L. Eder, None; D. Paran, None; O. Elkayam, None.

To cite this abstract in AMA style:

Polachek A, Furer V, Zureik M, Nevo S, Mendel L, Levartovsky D, Wollman J, Aloush V, Berman M, Kaufman I, Tzemach R, Anouk M, Elalouf O, Padova H, Carmi O, Eviatar T, Lahat goldstein Y, Sarbagil-Maman H, Borok Lev-Ran S, Broide A, Eder L, Paran D, Elkayam O. The Role of Ultrasound for the Assessment of Psoriatic Arthritis Patients with Fibromyalgia [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/the-role-of-ultrasound-for-the-assessment-of-psoriatic-arthritis-patients-with-fibromyalgia/. Accessed January 21, 2021.
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