FRI0562 Ultrasound Enthesitis in Primary Care Psoriasis Patients with Musculoskeletal Complaints

Abstract

BackgroundPsoriasis patients with enthesitis can classify as psoriatic arthritis since the introduction of the CASPAR classification criteria in 2006. However, clinical assessment of the entheses could be challenging. In addition, the presence of a tender enthesis is not necessarily indicative for underlying inflammatory disease as it could be related to overuse, metabolic disease or ageing. Therefore, we need a better way to identify the inflammatory component of entheseal involvement in psoriasis. To detect these inflammatory components in the entheses, ultrasound (US) examination can be used to identify inflammatory disease at the entheses.ObjectivesOur aims were to determine the prevalence of US abnormalities among psoriasis patients in primary care and to determine the concordance of clinical and US information at individual entheseal sites.MethodsAdult patients with psoriasis were invited to participate in the SENSOR study. Patients who reported pain in joints, entheses or the lower back were eligible for clinical evaluation. If physical examination indicated a painful enthesis on the LEI/MASES or if arthritis was present, US examination of the entheses was performed. The six entheses of the Madrid Sonographic Enthesis Index (MASEI) and the lateral epicondyle tendon insertion (elbow) were evaluated according to the MASEI scoring system. Enthesitis was defined as US inflammation (positive power Doppler (PD) signal or a thickened enthesis of the plantar fascia) in combination with one clinical feature at the same enthesis. Structural changes detected by ultrasound were calcifications, increased thickness, irregular fibre structure and erosions.ResultsOf 524 patients who participated in the SENSOR study, 111 patients were assessed both by physical examination and by US. In 106 (95%) patients we detected US abnormalities. In 56 (50%) patients we found structural changes without indication for inflammatory disease. In 50 (45%) patients we found US abnormalities indicating inflammatory disease at the enthesis (positive PD: n=35; thickened plantar fascia: n=15). When we combined the US data with the clinical information, 36% of US inflammatory disease were confirmed [Figure 1].ConclusionsWe found US abnormalities in 95% of the primary care psoriasis patients with musculoskeletal complaints, which is a combination of both structural and inflammatory US components. In 45% of primary care psoriasis patients we observed US inflammatory disease, which was confirmed in 36% of the patients by clinical information.AcknowledgementsThis study was financially funded by an investigator-initiated grant from Pfizer bv.Disclosure of InterestNone declared

The association between sonographic enthesitis and radiographic damage in psoriatic arthritis

“…A few studies that compared these two modalities found low to moderate agreement [ 43 , 44 ]. Recently, van der Ven et al reported that adding US evaluation in psoriasis patients who had entheseal tenderness on clinical examination reduced the rate of enthesitis by 64% [ 45 ]. In this regard, it should be mentioned that the MASEI score includes entheseal lesions that represent irreversible damage from prior active enthesitis, such as enthesophytes and erosions, in addition to active lesions such as vascularization.…”

Assessment of enthesitis in patients with psoriasis: Relationships with clinical features, screening questionnaries results, and quality of life: An ultrasound study

“…According to MASEI score, one subject had not any sign of US verified enthesitis. Mean value of MASEI score was high in our subjects (27). As MASEI score has cut off value ≥ 18, 75% of our patients with psoriasis and without diagnosis of PsA has significant enthesitis with score 32.6.…”

“…Similar to our results, enthesitis was detected by US in 37 patients (74%) with psoriasis and in 3 healthy controls (15%) with median MASEI scores 27.8 and 4.3 in healthy controls. In paper od Van der Ven and coauthors, in 542 primary care psoriasis patient which were US evaluated, 36% had with MASEI score greater than 18, but some typical structural changes were observed in 95% of the psoriasis patients 27 . At the contrary of our study, 97% of them were treated with systemic therapy (biologics or immunomodulatory drugs).…”

The Role of Ultrasound in Psoriatic Arthritis — Do We Need a Score?

“…In routine clinical practice, there has been an increase in the use of US for both diagnosis and monitoring of PsA. In borderline cases with psoriasis and musculoskeletal (MSK) pain, US can be very helpful to differentiate inflammatory synovitis or enthesitis from other common conditions including osteoarthritis (OA) and mechanical joint pain 13,14,15 . Once a diagnosis is established, US can also be used to quantify inflammation in joints and tendons if there is doubt in the clinical examination 13 .…”