Ultrasound assessment of enthesis thickening in psoriatic arthritis patients treated with adalimumab compared to methotrexate

Abstract

The objective of the study was to combine ultrasonographic (US) with clinical findings for comparing the effect of adalimumab (ADA) to methotrexate (MTX) on the thickness of tendons and enthesis in psoriatic arthritis (PsA) patients. Forty-three consecutive PsA patients were examined at baseline and after 6 and 12 weeks of treatment with ADA or MTX. The US assessment included thickness measurement of the extensor (ET) and flexor tendons (FT) of the second and third finger of both hands, plantar aponeurosis (PA) and the Achilles tendon (AT) bilaterally. Disease activity (DA) was assessed by the number of tender (TJ) and swollen joints (SJ), the number of inflamed enthesis (IE), pain assessment (PAI), and patient (PDAI) and physician (PHDAI) disease activity evaluations by visual activity score (VAS). Nineteen patients received MTX and 24 patients received ADA. All DA parameters improved in both groups. A decrease in thickness of tendons and enthesis was observed only in the ADA group, reaching a level of significance for the left AT (p = 0.01), left PA (p = 0.007), the second left FT (p = 0.04) and the third ET (p = 0.04). ADA patients showed a trend towards a better response to treatment compared to MTX patients that reach significance at week 6 of treatment for the thickness of left AT (p = 0.04), left PA (p = 0.03), the number of TJ (p = 0.0136), PAI (p = 0.0028), and PDAI (p = 0.029). ADA treatment for PsA compared to MTX significantly improved signs of DA and several US parameters. US assessment of enthesis can be an additional useful tool in the monitoring of psoriatic enthesopathy.

Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis

“…There is no data available on the effectiveness of methotrexate in the treatment of distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis. In a study by Litinsky et al, no change on US was observed in the thickness of the extensor and flexor tendons of the second and third fingers of both hands measured above the MCP joint line before and after 3 months of therapy with methotrexate in PsA patients [33]. In our study, methotrexate treatment resulted in a decrease of the extensor tendon thickness only in patients with Ps but not in PsA.…”

Ultrasound features of Achilles enthesitis in psoriatic arthritis: a systematic review

“…Five papers did not meet the eligibility criteria and were removed, thus 15 papers were included ( Table 3 ) [ 3 , 10 , 30–42 ]. The date of publication ranged from 2000 [ 36 ] to 2020 [ 31 , 34 ], with studies from Italy [ 30 , 32 , 34 , 36–38 ], Egypt [ 31 , 33 ], the UK [ 35 , 40 ], Kuwait [ 3 ], Israel [ 42 ], Norway [ 10 ], China [ 41 ] and The Netherlands [ 43 ].…”

“…Two studies identified PsA patients as a ‘control’ group (one as ‘inactive’ PsA and one comparing psoriasis to PsA) [ 3 , 33 ]. The majority of studies focussed exclusively on PsA [ 3 , 10 , 30 , 35 , 36 , 38–40 , 42 ]; however, other comparator groups included patients with psoriasis [ 33 , 41 ], FM [ 34 , 37 ], SpA [ 31 ] and other types of arthritis [ 32 ].…”

Enthesitis in Psoriatic Arthritis, the Sonographic Perspective

“…On the other hand, only few pilot studies have assessed the US ability to detect treatment induced changes at entheseal level in a limited number of PsA patients [ 63 , 64 ].…”

“…The scanning protocol was quite unusual, assessing only tendon thickness and including entheses (Achilles tendon and plantar fascia calcaneal insertions), tendons without synovial sheath (extensor digitorum tendons at the level of 2nd and 3rd metacarpophalangeal joints) and tendons with synovial sheath (flexor digitorum tendons at the level of 2nd and 3rd metacarpophalangeal joints). They found a trend towards a higher reduction in thickness of Achilles tendon and plantar fascia in the adalimumab group, even if the lack of PD examination represents a relevant limitation of this study [ 64 ].…”