Ultrasound verified enthesophytes are associated with radiographic progression at entheses in psoriatic arthritis

Abstract

Objectives The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA). Methods Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0–32) and power Doppler (0–14, range global ultrasound score 0–140)], and radiographs were evaluated for enthesophytes and erosions (score range 0–56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression. Results We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P =0.005), had shorter disease duration (9.7 vs 17.9 years, P=0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P=0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P<0.05). The multivariate regression analysis revealed that 48.6% of the variance of the X-ray score at 12-months follow-up (RegcoeffB = 0.827, P=0.000) could be explained by the baseline US enthesophyte score. Conclusion Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses.

High Frequency Ultrasound-Based Evaluation of Clinical Effect of Ephedra-Forsythia-Red Bean Decoction Addition and Subtraction Treatment of Psoriasis Vulgaris

“…Analysis of total PASI revealed that the total PASI scores of the two groups after treatment were significantly lower than those before treatment, and the total PASI score of the observation group after treatment were lower than those of the control group, and the difference had statistical significance ( P < 0.05). Such results were similar to the study by Lackner et al [ 27 ], indicating that the improvement effect of ephedra-forsythia-red bean decoction addition and subtraction in the treatment of psoriasis vulgaris was better than that of the control group. Further comparison of the efficacy indicators showed that the overall response rate (87.5%) in the observation group was significantly higher than that in the control group (67.5%), and the difference had statistical significance ( P < 0.05).…”

High Prevalence of Ultrasound Verified Enthesitis in Patients With Inflammatory Bowel Disease With or Without Spondylarthritis

“…Earlier studies in SpA and PsA demonstrated that ultrasound verified enthesitis does not correlate with clinical signs of enthesitis (20). We previously observed that enthesophytes but neither PD nor clinical tenderness at entheses were linked with radiographic enthesal progression (32). Whether similar result could be found in SpA and whether clinically quiescent but sonographically active enthesitis would predict future clinical worsening are questions that only future research can clarify.…”

Enthesitis in Psoriatic Arthritis, the Sonographic Perspective

“…The prevalence of syndesmophytes was higher in patients with than in those without US evidence of enthesophytes (26% vs 6%) [54]. Furthermore, a very recent study by Lackner et al reported that US baseline enthesophytes at the MASEI entheseal sites were predictive of radiographic progression at entheseal level after 12 months in a cohort of 43 PsA patients [55].…”

“…Furthermore, a very recent study by Lackner et al reported that US baseline enthesophytes at the MASEI entheseal sites were predictive of radiographic progression at entheseal level after 12 months in a cohort of 43 PsA patients [ 55 ].…”

“…PsA is a multi-faceted disease, characterized by a considerable variability in terms of inflammation and consequent damage, ranging from oligosymptomatic involvement to a destructive arthropathy, in which the various domains of the psoriatic disease may be differently combined. Evidence is growing on the possible link between entheseal and joint pathology, in particular US enthesopathy has been correlated with a higher burden of radiographic damage at both axial and peripheral level [53][54][55][56][57].…”