Objective.We aimed to investigate the prevalence of ultrasonographic (US) lesions in healthy entheses and contributing factors.Methods.US scans were performed on 960 entheses of 80 healthy subjects. Factors contributing to entheseal changes were investigated with regression analysis.Results.Thickening (20.4% of the entheses) and enthesophytes (23.1%) were the most common inflammatory and structural damage lesions, respectively. Age (p < 0.001), male sex (p = 0.003), body mass index (BMI; p = 0.001), and high physical activity (p = 0.007) were independent predictors of enthesitis scores on US.Conclusion.The effects of age, sex, BMI, and physical activity on the entheses need to be considered when differentiating disease from health.

ObjectivePsoriatic arthritis (PsA) has a genetic background. Approximately 40% of patients with psoriasis or PsA have a family history of psoriasis or PsA, which may affect disease features. The aim of this study was to assess the effects of family history of psoriasis and PsA on disease phenotypes.MethodsData from 1,393 patients recruited in the longitudinal, multicenter Psoriatic Arthritis International Database were analyzed. The effects of family history of psoriasis and/or PsA on characteristics of psoriasis and PsA were investigated using logistic regression.ResultsA total of 444 patients (31.9%) had a family history of psoriasis and/or PsA. These patients were more frequently women, had earlier onset of psoriasis, more frequent nail disease, enthesitis, and deformities, and less frequently achieved minimal disease activity. Among 444 patients, 335 only had psoriasis in their family, 74 had PsA, and 35 patients were not certain about having PsA and psoriasis in their family, so they were excluded from further analysis. In the multivariate analysis, family history of psoriasis was associated with younger age at onset of psoriasis (odds ratio [OR] 0.976) and presence of enthesitis (OR 1.931), whereas family history of PsA was associated with lower risk of plaque psoriasis (OR 0.417) and higher risk of deformities (OR 2.557). Family history of PsA versus psoriasis showed increased risk of deformities (OR 2.143) and lower risk of plaque psoriasis (OR 0.324).ConclusionFamily history of psoriasis and PsA impacts skin phenotypes, musculoskeletal features, and disease severity. The link between family history of psoriasis/PsA and pustular/plaque phenotypes may point to a different genetic background and pathogenic mechanisms in these subsets.

ObjectiveContemporary biologic therapies for psoriasis are independently licensed for psoriatic arthritis (PsA). Since skin disease generally predates PsA and PsA has a subclinical phase, we investigated the pattern of PsA evolution in psoriasis treated with biologic agents compared to other medications including oral therapy, topical agents or no treatments. Methods A retrospective chart review was performed in psoriasis patients with musculoskeletal symptoms referred for rheumatological assessment. Patients who had a final diagnosis of PsA were identified. The frequency and clinicalfeatures of PsA were compared for biologics versus the other strategies. ResultsBetween 2015 and 2018, 203 psoriasis patients were referred for musculoskeletal symptoms with 25 on biologics, 31 on non-biologic systemic therapies and 147 on topical/no therapies. A final diagnosis of PsA was similar in all groups (biologics: 36%; non-biologic systemic treatments: 35.4%; none/local treatments: 37.4%). Most patients had musculoskeletal symptoms before systemic therapy initiation but new onset PsA was evident in 12% (3/25) biologics treated patients, 9.6% (3/31) in non-biologic systemic therapy patients and was significantly higher in patients on topical/no therapy (55/147; 37.4%, p<0.001). Among patients with PsA, none of the patients on biologics exhibited dactylitis compared to 28.6% of other systemic treatments and 48.6% of none/local treatments (p=0.046). Conclusion New symptoms and signs leading to PsA diagnosis appear to decrease with systemic treatments.The characteristic PsA dactylitis lesion was not evident in the biologic therapy group.

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OBJECTIVE: Diabetes mellitus (DM) is a chronic hyperglycemic state and is associated with microvascular structural alterations. This study aimed to investigate the diameters of capillary loops and morphostructural changes using nailfold video capillaroscopy (NVC) in patients with type 2 DM with and without diabetic retinopathy (DR). METHODS: This cross-sectional, single-center study was conducted in patients with type 2 DM who were followed in outpatient clinics of ophthalmology and internal medicine. General demographic data were collected from patients. An ophthalmologist examined all patients in terms of DR. A rheumatologist blinded to the clinical data performed NVC. The diameters of apical, arterial, and venous loop of capillaries were measured, and the microvascular changes of capillaries were scored. RESULTS: In this study, 44 patients with type 2 DM with DR (47.7% males) and 20 patients with type 2 DM without DR (55% males) were included. In our study, patients with type 2 DM with DR had more frequent capillary hemorrhage, more frequent ectasia, more frequent giant capillary, and more frequent neo-angiogenesis than patients with type 2 DM without DR. However, these findings were not statistically significant. CONCLUSION: Further controlled studies with large sample size are needed to determine the characteristic NVC findings of DR in patients with type 2 DM.

ObjectiveTo explore the impact of early versus late-onset psoriasis (PsO) on the disease characteristics of psoriatic arthritis (PsA) in a large-multicentre cohort. MethodsThe data from a multicentre psoriatic arthritis database was analysed. Patients were grouped according to age at psoriasis onset (early onset; <40 years of age, late-onset; >40 years of age) and disease characteristics of the groups were compared by adjusting for BMI and PsA duration, where necessary. Results At the time of analyses, 1634 patients were recruited [62.8% females; early onset 1108 (67.8%); late-onset, 526 (32.2%)]. The late-onset group was more over-weight [66.8% vs. 86.8%, p<0.001; adjusted for age -aOR 1.55 (1.11-2.20; 95% CI)]. The early onset group had more scalp psoriasis at onset (56.7% vs. 43.0%, p<0.001), whereas extremity lesions were more common in the late-onset group (63.8% vs. 74.2%, p<0.001). Axial disease in males and psoriatic disease family history in females were significantly higher in the early onset group [38.0% vs. 25.4%; p=0.005; adjusted for PsA duration -aOR 1.76 (1.19-2.62; 95% CI) / 39.5% vs. 30.1%; p=0.003; OR 1.51 (1.15-1.99; 95% CI), respectively]. Psoriatic disease activity parameters, patient-physician reported outcomes and HAQ-DI scores were similar in both groups. Conclusion Clinical features of PsA may be affected by the age at onset of PsO. Different genetic backgrounds in early and late-onset PsO may be driving the differences in psoriasis and PsA phenotypes.

ObjectiveUltrasound (US) is increasingly used to evaluate enthesitis. One of the US features of enthesitis is thickening. However, there is no consensus on how the entheseal thickening needs to be defined, and existing cut-off levels have been criticized for being frequently positive in healthy controls (HCs). Our objective was to determine the frequency of thickening of entheses on US using the existing cut-off values in HCs and in patients with axial spondyloarthritis (axSpA) and propose new values to improve discriminative value.MethodsEighty HCs and 100 patients with axSpA had US scans of 2160 entheses. Sensitivity, specificity, odds ratio (OR), and accuracy were calculated according to accepted cut-off levels from the literature and proposed cut-offs were calculated as the mean ± 2 SD.ResultsThickening according to current cut-off levels was found in 20.4% (196/960) of healthy participants' entheses and 33% (396/1200) of entheses of patients with axSpA. Thickening according to proposed cut-off levels decreased frequency of thickening in both groups, and therefore increased specificity at the cost of decreasing sensitivity. The only anatomical site where the thickness had a value to discriminate disease from health was seen at the triceps tendon enthesis with an OR of 13.4 (95% CI 4.0-44.8) according to the current cut-offs compared to 10.3 (95% CI 4.0-26.6) with the proposed cut-off levels.ConclusionAlthough using cut-offs appears to be an appealing method to evaluate entheseal thickness, the measurements may be affected by several confounding factors, leading to a low discriminative value, except for at the triceps tendon enthesis.