Background/Purpose: To compare sonography verified inflammation of entheses, tendons and joints with corresponding clinical findings in psoriasis arthritis (PsA) patients.

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 clinical scores including the Disease Activity index for PSoriatic Arthritis (DAPSA), composite psoriatic disease activity index (CPDAI), dactylitis score, Leeds enthesitis index (LEI), HAQ and PASI were calculated. Sonography was performed by two rheumatologists blinded to clinical data using an ESAOTE Twice ultrasound device. Synovial hypertrophy and/or joint effusion (SH/E) as well as Power Doppler (PD) were graded at each joint from 0 to 3 in accordance with prior publications. At hands and feet we also recorded the presence of perisynovitis and tenosynovitis. For grading of enthesitis by ultrasound the MASEI and GUESS scores were used. Ultrasound signs of dactylitis were defined by the presence of synovitis plus tenosynovitis at MCP/MTP, PIP and  DIP joints.

Results: The median DAPSA was 12.1 (0.1-70.2), mean CPDAI 4.8 (±2.5), median clinical Dactylitis score 0 (0-10), median LEI 0 (0-4), mean HAQ 0.73 (±0.81) and median PASI 1.0 (0-23.2). Using sonography, we found SH/E and/or PD at 12 (range 3-35) [median SH/E score 16.0 (range 3.0-56.0)] and/or 2 (0-19) [PD-score 3.0 (0-31.0)] joints, respectively. Eighteen patients (25.7%) had evidence of perisynovitis in at least one MCP joint and 20 (28.6%) patients demonstrated flexor tenosynovitis affecting at least one whole finger or toe. Median MASEI and GUESS scores were 32.5 (7.0-73.0) and 13.0 (4.0-27.0), respectively. Ultrasound signs of dactylitis were found in 5 (7.1%) patients.

DAPSA showed a moderate correlation with total SH/E (corrcoeff 0.35, p=0.003) and PD-scores (corrcoeff 0.36, p=0.002), as well as with the number of joints affected by SH/E (corrcoeff 0.24, p=0.045) and/or PD (corrcoeff 0.32, p=0.006). Total CPDAI did not correlate with SH/E, PD, enthesitis or dactilytis scores; however, within the CPDAI-joint domain we found differences concerning SH/E- and PD-scores between patients with no [n=17, median SH/E 12.0 (3.0-32.0); PD-score 1.0 (0-11.0)] and moderate [n=17, SH/E 25.0 (6.0-43.0), p=0.009; PD 5.0 (0-31.0), p=0.005] or high clinical activity [n=26, SH/E 18.5 (6.0-56.0), p=0.025; PD 5.5 (0-30.0), p=0.005). In the CPDAI enthesitis and dactilyitis domains no differences were found, comparing the MASES / GUESS and ultrasound defined dactylitis, respectively between the groups. No correlation was found between clinical and sonographic dactylitis scores; or LEI (clinical) and MASEI / GUESS (sonography).

Conclusion: No association was found between sonographic and clinical assessment of enthesitis and dactylitis in PsA patients. Ultrasound verified joint inflammation moderately correlated with DAPSA and CPAI joint components .

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-scores-of-enthesitis-and-dactylitis-do-not-correlate-with-corresponding-clinical-findings-in-psoriasis-arthritis/