Enthesitis

2016 ◽  
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Enthesitis

2013 ◽  
pp. 398-403
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents and other biologics have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Enthesitis

2013 ◽  
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritides (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term 'enthesis organ' has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Treating to target in psoriatic arthritis: how to implement in clinical practice

2015 ◽  
Vol 75 (4) ◽  
pp. 640-643 ◽  
Author(s):  
Laura C Coates ◽  
Philip S Helliwell
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Standard Of Care ◽  
Routine Clinical Practice ◽  
Tight Control ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Medical Specialities ◽  
Optimal Measure ◽  
European League

Treating to target is becoming the standard of care in many medical specialities, including rheumatology. The Tight Control of Psoriatic Arthritis (TICOPA) trial has recently provided evidence of the benefit of treating to target in psoriatic arthritis (PsA), and the revised European League Against Rheumatism (EULAR) recommendations on the management of PsA suggest this approach. However, the question of the optimal measure to use and the practicalities of incorporating this into routine clinical practice remain problematic.

scholarly journals AB0495 BIOMECHANICAL STRESS IN THE CONTEXT OF COMPETITIVE SPORTS TRAINING TRIGGERS ENTHESITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1275.1-1275
Author(s):  
D. Simon ◽  
A. Kleyer ◽  
S. Bayat ◽  
J. Knitza ◽  
L. Valor ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Mechanical Stress ◽  
Power Doppler ◽  
Mean Value ◽  
Mixed Effects ◽  
P Value ◽  
Biomechanical Stress ◽  
Score Difference ◽  
Before And After ◽  
The Mean

Background:Preclinical models have indicated that biomechanical stress can trigger entheseal inflammation (1). Furthermore, enthesitis is a hallmark of psoriatic arthritis (PsA) and spondyloarthritis (SpA), suggesting that mechanoinflammation is an important step in their pathogenesis (2). However, the relation between mechanical stress and enthesitis in humans is poorly investigated. Competitive badminton is a demanding stop-and-go sport that strains entheseal sites in particular and provides an opportunity to assess the impact of physical activity on the development of an instant inflammatory response in the entheses.Objectives:To evaluate the influence of mechanical stress on the development of immediate enthesitis.Methods:BEAT (Badminton Enthesitis Arthrosonography Study) is an interventional study that assessed entheses in competitive badminton players before and immediately after a 60-minute intensive training session by ultrasound. Power Doppler (PD) signal and Gray-Scale (GS) changes were evaluated at the insertions sites of both Achilles tendon, patellar tendons and lateral humeral epicondyles and quantified using a validated scoring system (3). Pre- and post-training scores were compared using linear mixed-effects models. We used interaction terms to assess possible differential effects on patellar, elbow and Achilles entheses.Results:Thirty-two badminton players (22 men, 10 women) with an average age of 31.1±13.0 years were included (Table 1). On average, they had been playing badminton for 16.2±10.1 years. 192 entheseal sites were examined twice. The respective empirical total scores for PD examination were 0.1 (0.3) before and 0.5 (0.9) after training (Figure 1). Mean total GS scores were 2.9 (2.5) and 3.1 (2.5) before and after training, respectively. The mean total PD score difference of 0.4 between pre- and post -training was significant with a p value of 0.0014, whereas the p value for the mean total GS score difference of 0.2 was 0.63. Overall, seven participants (22%) showed an increased empirical total PD score. A mixed-effects model showed a significant increase of PD scores after training, with a mean increase per site of 0.06 (95%CI 0.01 to 0.12, p=0.017).Table 1.Baseline characteristicsDemographic characteristicsN, total32Females, N (%)10 (31.3)Age, years (mean ± SD)36.1 ± 13.0Height, cm (mean value ± SD)178.6 ± 9.9Body weight, kg (mean value ± SD)74.7 ± 13.5Smoking, N (%)11 (34.4)Alcohol, N (%)24 (75.0)Concomitant DiseasesInflammatory bowel disease, N (%)0Psoriasis, N (%) 0Uveitis, N (%)0Diabetes mellitus, N (%)0Hypertension, N (%)2 (6.3)Sports historyYears Badminton (mean ± SD)16.2 ± 10.1Figure 1.Ultrasound scores before and after training Figure 1. A Spaghetti plots depicting inividual Gray-Scale and Power Doppler ultrasound scores before and after trainingConclusion:Mechanical stress leads to rapid inflammatory responses in the entheseal structures of humans. These data support the concept of mechanoinflammation in diseases associated with enthesitis. However, while such responses may be self-contained in healthy subjects, they may be prolonged and more pronounced in certain risk groups, such as patients with PsA or SpA.References:[1]Cambré I, et al. Mechanical strain determines the site-specific localization of inflammation and tissue damage in arthritis. Nature Communications. 2018; 9:4613.[2]Schett G, et al. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol. 2017; 13:731-741.[3]Balint PV, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Annals of the Rheumatic Diseases. 2018; 77:1730.Disclosure of Interests:David Simon: None declared., Arnd Kleyer: None declared., Sara Bayat: None declared., Johannes Knitza: None declared., Larissa Valor: None declared., Marina Schweiger: None declared., Georg Schett: None declared., Koray Tascilar: None declared., Axel Hueber Grant/research support from: Novartis Research Grant.

scholarly journals European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

2015 ◽  
Vol 75 (3) ◽  
pp. 499-510 ◽  
Author(s):  
L Gossec ◽  
J S Smolen ◽  
S Ramiro ◽  
M de Wit ◽  
M Cutolo ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Expert Opinion ◽  
Pharmacological Treatment ◽  
Task Force ◽  
Local Therapy ◽  
Initial Therapy ◽  
Tnf Inhibitor ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
European League

BackgroundSince the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.MethodsA systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.ResultsThe updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.ConclusionsThese recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.

scholarly journals European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies

2011 ◽  
Vol 71 (1) ◽  
pp. 4-12 ◽  
Author(s):  
L Gossec ◽  
J S Smolen ◽  
C Gaujoux-Viala ◽  
Z Ash ◽  
H Marzo-Ortega ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Research Agenda ◽  
Task Force ◽  
Optimal Outcomes ◽  
Eular Recommendations ◽  
Evidence Strength ◽  
European League Against Rheumatism ◽  
Combining Evidence ◽  
Musculoskeletal Manifestations ◽  
European League

BackgroundPsoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD).MethodsThe recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement.ResultsTen recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined.ConclusionThese recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

scholarly journals Can spectral doppler high specificity and gray scale nail assessment suggest inflammation in psoriatic arthritis patients and control groups?

2021 ◽  
Vol 13 (5) ◽  
pp. 137-142
Author(s):  
José Alexandre Mendonça ◽  
Vânia Aparecida Leandro-Merhi, ◽  
José Luis Braga de Aquino
Keyword(s):  
Psoriatic Arthritis ◽  
Statistical Significance ◽  
Power Doppler ◽  
Resistance Index ◽  
Hand Osteoarthritis ◽  
Gray Scale ◽  
Control Groups ◽  
Cross Sectional ◽  
Study Results ◽  
Spectral Doppler

Introduction: The use of high resolution ultrasonography (US) has become a very important tool in nail assessment. This study evaluated nails clinical and ultrasound measurements in psoriatic arthritis (PsA) patients. Methods: A cross sectional study was performed with a total of 60 patients, PSA patients, 10 healthy individuals and 6 hand osteoarthritis patients (OA). Only PsA patients meeting the CASPAR criteria were included in the study. Results: Spectral Doppler (sD) was used to analyze 208 nail beds. Nail plates on the gray scale (GS) showed loss of the normal three-layered pattern in 89 nails (45.9%). Power Doppler (PD) signal was detected in 189 nail beds (92.2%), showing inflammatory activity in most of the patients and nails assessed. Resistance index (RI) was significantly lower in PsA patients as compared to control groups in both the longitudinal and transverse planes (p<0.001).Nail enthesitis was observed when RI values were below 0.4, characterizing 100% sensitivity and 96% specificity (p<0.01). Conclusions: Nail US scanning presented statistical significance in PsA patients. Future studies could show many inflammatory situations, requiring treatment assessment.

scholarly journals SAT0415 AGE RELATIONSHIP WITH ULTRASOUND ARTICULAR AND ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS: CROSS-SECTIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1160.2-1161
Author(s):  
I. Fairushina ◽  
D. Abdulganieva ◽  
E. Kirillova ◽  
R. Abdrakipov
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Power Doppler ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Blood Biomarkers ◽  
Cross Sectional ◽  
Age Related ◽  
Hs Crp ◽  
Axial Involvement

Background:Detection of subclinical enthesitis and synovitis in psoriatic arthritis (PsA) is prevalent and ultrasound (US) examination is informative tool for it diagnosing. Aging positively affects degenerative changes.Objectives:To study relationship between US articular and entheseal findings with age in patients with PsA.Methods:57 patients were enrolled to study with fulfilled PsA criteria (CASPAR, 2009). Data collection: demographical, clinical (current psoriasis, axial involvement, enthesitis, dactylitis), US (synovitis count (by Grey Scale), Power Doppler(PD)+ synovitis), thickening and hypoechogenicity at enthesis, PD+ enthesitis, entheses with structural components); biological (high sensitive C-reactive protein (hsCRP), Erythrocyte Sedimentation Rate (ESR).US examination included 798 joints and 3078 entheses (bilateral shoulders, acromioclavicular joints, elbows, wrists, hips, knees, ankles; entheses at the projection of these joints (total number - 54). US entheseal findings were fixed according to consensus-based US definition and scoring for enthesitis in spondyloarthritis and PsA (OMERACT US)1.Results:In all 57 patients: male - 25 (43.9%), mean age 43.4±10.3(SD) years (y), PsA duration was 7 (3;10) y, Ps duration 10 (8; 22) y; 53 (41.1%) had axial involvement, 42 (73.7%) dactylitis, 8 (14%) clinical enthesitis, and 56 (98.2 %) skin psoriasis, Psoriasis Activity and Severity Index score 6.4 (2;14.4), Disease Activity in PsA score 18.1 (10.2;26.1), hsCRP 10.1(2.4;21.4), ESR 20 (11.3;31.5).Synovitis count increased with age noticeably (r=0.508, p<0.01), and weak correlation of PD+ synovitis (r=0.262, p=0.049) and age was found. The entheseal thickening and hypoechogenicity and structural findings increased with age respectively (r=0.345, p=0.009; r=0.337, p=0.01). There was no correlation between PD+ enthesitis and age. The assosiation between PD+ enthesitis and blood biomarkers of inflammation (hs-CRP (r=0.364, p=0.008); ESR (p=0.358, p=0.008) was found.Conclusion:Our study found significant relationship between age and US synovitis. Association between age and US entheseal involvement was noted. Only PD+ enthesitis was not related with age in comparison with other US entheseal findings. The presence of PD US signal at enthesitis in association with increased inflammatory blood biomarkers can be evaluated as the sign of disease activity regardless of age and not as age-related lesion in PsA patients.References:[1]Balint PV, Terslev L, Aegerter P et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis.;2018;77(12):1730-1735.Disclosure of Interests:None declared

scholarly journals THU0538 IN PSORIATIC ARTHRITIS PATIENTS CONSIDERED IN REMISSION BY THEIR RHEUMATOLOGIST, CAN DISCORDANCE IN DISEASE ACTIVITY ASSESSMENT BETWEEN PATIENT AND RHEUMATOLOGIST BE EXPLAINED BY RESIDUAL INFLAMMATION AS MEASURED BY ULTRASONOGRAPHIC EXAMINATION?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 508-508
Author(s):  
M. Moly ◽  
C. Lukas ◽  
J. Morel ◽  
B. Combe ◽  
G. Mouterde
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Power Doppler ◽  
Minimal Disease Activity ◽  
Activity Assessment ◽  
Grey Scale ◽  
Minimal Disease ◽  
Disease Activity Assessment

Background:Psoriatic arthritis (PsA) is a heterogeneous disease and its assessment is sometimes difficult. Perception of disease activity by patient and physician is frequently discordant in patients in clinical remission. Ultrasound (US) is an imaging technique, which can detect inflammation in PsA.Objectives:The aim of our study was to assess whether persistence of disease activity evaluated by the patient, considered in remission by his rheumatologist, was associated with inflammation measured by US.Methods:We performed a transversal monocentric study. PsA patients were included if they met the CASPAR criteria and were considered in remission by their rheumatologist. Demographic data, characteristics of the disease and treatments were collected. Discordance was defined by a difference between patient’s and rheumatologist’s global assessment ≥30/100 on a Visual Analogic Scale. An US examination was performed on 50 joints, 28 tendons and 14 entheses by an independent investigator. Synovial or tendon sheath hypertrophy and PD signal were evaluated on a semi-quantitative scale, B Mode and PD signal abnormalities on entheses were searched, according to the EULAR-OMERACT scoring system. US remission was defined by no power Doppler (PD) signal on joints, tendons and entheses and minimal US activity by maximum one PD signal on the same sites. Univariate and multivariate analyses were performed to evaluate factors associated with US abnormalities.Results:Sixty-two PsA patients were included. 40.3% were women, the mean (SD) age was 55 (14) years, 42% were in US remission and 71% in minimal US activity (Table 1), 19.4% had ≥1 PD synovitis and 88.7% had a B mode synovitis, 95.2% had a B mode abnormality on entheses and 51.6% had ≥1 PD signal on entheses. Thirty nine percent had a discordant disease activity assessment with their rheumatologist. In univariate analysis, discordance was not associated with US remission (OR=1.71 (95%CI 0.61-4.83), p=0.224) or US minimal disease activity (OR=0.99 (95%CI 0.32-3.05), p=0.602). In multivariate analysis, US remission was independently associated with female gender (OR=3.94 (95%CI 1.20-12.9), p=0.024) and younger age (OR=0.95 (95%CI 0.91-0.99), p=0.027). Minimal US activity was associated with history of enthesis lesion (OR=11.26 (95%CI 1.34-94.93), p=0.026) and age (OR=0.95 (95%CI 0.90-1), p=0.044).Table 1.Ultrasound characteristics of the 62 PsA patients.N (%)Ultrasound remission26 (41.9)Ultrasound minimal disease activity44 (71)Patients with ≥1 grey scale synovitis55 (88.7)Patients with ≥1 Power Doppler synovitis12 (19.4)Patients with ≥1 grey scale tenosynovitis15 (24.2)Patients with ≥1 Power Doppler tenosynovitis1 (1.6)Patients with ≥1 grey scale enthesitis lesion (thickness, hypo echogenicity, calcification, enthesophyte, erosion, bursitis)59 (95.2)Patients with ≥1 Power Doppler enthesitis32 (51.6)Conclusion:Our study showed persistent inflammation evaluated by US in PsA patients considered in remission by their rheumatologist. However, prevalence of residual inflammation evaluated by US was not higher in patients with self-assessment of their disease discordant from their rheumatologist.Disclosure of Interests:Marie Moly: None declared, Cédric Lukas: None declared, Jacques Morel: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Gael Mouterde: None declared

scholarly journals FRI0342 POST-EFFORT SYNOVIAL AND ENTHESIC RESPONSE IN PATIENTS WITH PSORIATIC ARTHRITIS IN REMISSION OF LOW DISEASE ACTIVITY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 765.2-765
Author(s):  
C. Guillén-Astete ◽  
P. Zurita-Prada ◽  
C. Urrego-Laurín
Keyword(s):  
Disease Activity ◽  
Power Doppler ◽  
Control Group ◽  
Healthy Population ◽  
Dominant Hand ◽  
Synovial Joint ◽  
Low Disease Activity ◽  
Post Exercise ◽  
Eular Recommendations ◽  
The Mean

Background:Synovial inflammation is part of the pathophysiological process of PsoA although it is considered secondary to enthesitis. It is of interest to assess the synovial joint, peritendinous and enthesic response of patients with PsoA in remission under controlled mechanical stress.Objectives:Our aim is to present our observational experience in patients with APso in remission or low activity of the disease exposed to controlled manual physical efforts adapted to the own grasping capacity of each subject.Methods:Before-after study of a consecutive cohort of patients with PsoA (CASPAR criteria), of at least two years d evolution and DAPSA≤14 at present. Patients with positive rheumatoid factor, patients with exclusively axial forms and patients on biological therapy at the beginning of the study were excluded. All patients underwent controlled basal ultrasound and post-dynamometric exercise (CAMRY EH101-17) of the dominant hand which included the carpus, MCFs, IFPs and IFDs of the 2nd to 5th fingers. The ultrasound findings were scored according to EULAR recommendations in grey scale (GS) and power Doppler (PD) for synovitis, enthesitis and tenosynovitis (maximum scores 71 and 87, respectively). For statistical analysis, comparisons were made with the results of their baseline and post-exercise ultrasound scores between subjects diagnosed with PsoA and controls. The Student’s T test was used for related and unrelated data according to correspondence.Results:Nineteen patients and controls were included, of which 73.7% were male. Mean age: 42.2 SD 6.6 and 42.21 SD 8.28, respectively. Basal DAPSA among patients: 7.26 SD 4.53. Mean traction strength of patients and controls: 23.8 SD 7.3 and 26.1 SD 6.9 kg, respectively (P=0.336). In the group of patients, the post exercise DAPSA had a mean of 7.52 SD 4.62 (P=0.021, with respect to the basal DAPSA). The mean total GS score in the patient group was 3.94 SD 2.36 and 7.31 SD 3.3, pre- and post-exercise, respectively (P<0.001). The mean total score in the PD study was 0.73 SD 0.73 and 2.57 SD 1.16, respectively (P<0.001). In patients with PsoA there were no detectable enthesic changes. In the control group, no ultrasound changes were statistically significant, although the score for tenosynovitis ranged from 0.1 SD 0.31 to 0.42 SD 0.6 (P=0.055).Conclusion:Patients with APso in clinical remission or low disease activity develop ultrasound changes after controlled exercise. These changes are appreciable in the joint synovium and tendon but not at an enthesic level. Although these changes are also detectable in a healthy population, their prevalence is much lower. Our interpretation is that control of the disease correlates with an absence of enthesic inflammatory activity although synovial susceptibility remains less evident. This reinforces the idea that PsoA is an inflammatory enthesitis with associated arthritis and not its opposite.Disclosure of Interests:None declared

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