THU0372 Subclinical Joint Inflammation in Psoriasis Patients without Concomitant Psoriatic Arthritis- A Cross-Sectional and Longitudinal Analysis
Authors: F. Faustini, D. Simon, I. Oliveira, A. Kleyer, J. Haschka, M. Englbrecht, A. Cavalcante, S. Kraus, T. Tabosa, C. Figueiredo, A. Hueber, R. Kocijan, A. Cavallaro, G. Schett, M. Sticherling, J. Rech
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Psoriasis is a chronic inflammatory disease affecting 2–3% of the population [1,2]. Up to 30% of psoriasis patients develop psoriatic arthritis (PsA), and usually musculoskeletal symptoms start after the onset of skin disease. Psoriatic skin disease has a higher prevalence than arthritis what raises the question whether psoriasis patients without PsA are indeed spared from joint inflammation [3]. Detecting subclinical joint inflammation could help identify which patients with skin disease would benefit of treatment covering both skin and musculoskeletal inflammation. <h3>Objectives</h3> To search for subclinical inflammatory joint disease in psoriasis patients without arthritis, and to determine whether such changes are associated with the later development of PsA. <h3>Methods</h3> Eighty-five subjects without arthritis (55 with psoriasis and 30 healthy controls) received high field magnetic resonance imaging (MRI) of the hand. MRI scans were scored according to the PSAMRIS method [4]. Psoriasis patients received complete clinical investigation, high-resolution peripheral quantitative computed tomography (HR-pQCT) to detect erosions and enthesiophytes and were followed up for at least one year for the development of PsA. <h3>Results</h3> 47% of psoriasis patients showed at least one inflammatory lesion on MRI. Synovitis was the most prevalent inflammatory lesion (38%), while osteitis (11%), tenosynovitis (4%) and periarticular inflammation (4%) were less frequent. The mean (±SD) PSAMRIS synovitis score was 3.0±2.5 units. Enthesiophytes and bone erosions were not different between psoriasis patients with or without inflammatory MRI changes. The risk for developing PsA was as high as 55% if patients had subclinical synovitis and symptoms related to arthralgia, but only 15% of patients had normal MRIs and did not report of arthralgia. <h3>Conclusions</h3> Prevalence of subclinical inflammatory lesions is high in patients with cutaneous psoriasis. Arthralgia associated with MRI synovitis constitutes a high-risk constellation for the development of PsA. <h3>References</h3> Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol 2013;69:729–35. McGonagle D, Ash Z, Dickie L, et al. The early phase of psoriatic arthritis. Ann Rheum Dis 2011;70 Suppl 1:i71–6. Palazzi C, Lubrano E, D9Angelo S, et al. Beyond early diagnosis: occult psoriatic arthritis. J Rheumatol 2010;37:1556–8 Ostergaard M, McQueen F, Wiell C, et al. The OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS): definitions of key pathologies, suggested MRI sequences, and preliminary scoring system for PsA Hands. J Rheumatol 2009;36:1816–24. <h3>Acknowledgement</h3> This study was supported by the Deutsche Forschungsgemeinschaft (SPP1468, CRC1181), the Marie Curie project OSTEOIMMUNE, the Metarthros project of the German Ministry of Science and Education, the IMI-funded project BTCure and the Pfizer Competitive Grant Award Germany. <h3>Disclosure of Interest</h3> None declared