SAT0305 Assessment of sub clinical hand joint synovitis in patients with psoriatic arthritis and psoriasis by ultrasound and its relationship with clinical disease activity
Authors: S. Mondal, R.P. Goswami, D. Sinha, G.B. Sircar, A.K. Das, P. Ghosh, A. Ghosh
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Articular involvement in Psoriatic arthritis (PsA) can have diverse presentations; oligoarticular involvement is predominant in early disease. Ultrasound (US) detected subclinical synovitis can be present in early PsA and a substantial portion of oligoarthritic PsA patients are being reclassified as having polyarthritis.<sup>1</sup> Asymptomatic US synovitis and enthesopathy can be present in Psoriasis (Pso) patients which probably indicate subclinical musculoskeletal involvement.<sup>2</sup> <h3>Objectives</h3> To evaluate sub–clinical synovitis of hand joints in patients with PsA and Pso by B–mode and Power Doppler US. Correlation of PsA and Pso disease activity with US detected synovitis. <h3>Methods</h3> 27 patients of PsA (disease duration &lt;2 years, no clinical evidence of hand joint involvement), 36 Pso patients and 30 controls were recruited. PASI and DAPSA score used for assessment of cutaneous and articular disease activity respectively. US [grey scale (GS) and power Doppler (PD)] used to assess synovitis of hand joints. A GS score ≥2 and/or a PD score ≥1 were used to identify US detected synovitis. <h3>Results</h3> Significantly more patients with PsA had sub-clinical hand joint synovitis than controls (62.96% versus 20%, p value=0.001, relative risk: 3.148, 95% C.I: 1.455 to 6.814), and Pso patients [(27.78%), p value=0.0095, relative risk=2.267, 95% C.I: 1.243 to 4.135]. Median number of joints involved in PsA group was 4 (inter quartile range: 2–5). Among 810 hand joints scanned in PsA group, 59 (7.28%) joints showed evidence of sub-clinical synovitis. Wrist joint was most commonly involved (28.81%), followed by DIP3 (13.56%) and MCP3 (10.17%). Less involvement noted in MCP4, MCP5, PIP1, PIP5 and DIP5 (1.69%). In Pso patients, evidence of sub-clinical synovitis was not significantly different from control. (p value=0.5689, relative risk=1.389, 95% C.I: 0.5710 to 3.378). However, wrist and DIP involvement was significantly more in Pso than control. No correlation noted between numbers of joints with subclinical synovitis with DAPSA or PASI score. <h3>Conclusions</h3> Almost two third patients with early PsA had PDUS evidence of sub–clinical synovitis in hand joints, most commonly in wrist joint followed by DIP3 and MCP3. No significant increase of sub–clinical synovitis in Pso compared to control group. However, wrist and DIP joint involvement was significantly more in Psoriasis. There was no correlation between number of joints with sub–clinical synovitis and disease activity indices. <h3>References</h3> [1] Freeston JE, Coates LC, Nam JL, et al. Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care Res (Hoboken)2014Mar;66(3):432–9. [2] Naredo E, Möller I, de Miguel E, et al. High prevalence of ultrasonographic synovitis and enthesopathy in patients with psoriasis without psoriatic arthritis: a prospective case-control study. Rheumatology (Oxford)2011;50(10):1838–48. <h3>Disclosure of Interest</h3> None declared