AB1091 FREQUENCY OF ULTRASOUND ENTHESITIS AND SYNOVITIS IN DIFFERENT ANATOMICAL SITES OF UPPER AND LOWER EXTREMITIES IN PATIENTS WITH PSORIATIC ARTHRITIS: CROSS-SECTIONAL STUDY
Authors: I. Fairushina, D. Abdulganieva, E. Kirillova, E. Mukhametshina
Journal: Annals of the Rheumatic Diseases (2020)

Background: Psoriatic arthritis (PsA) is characterized by asymptomatic enthesitis and synovitis 1 . The location of pathological lesions is not clear. Furthermore, ultrasound (US) enthesitis indices assess limited number of entheses. Objectives: To detect the most frequent sites of US enthesitis and synovitis in PsA. Methods: 57 PsA patients were enrolled to the study. US examination included bilateral large 14 joints; entheses of tendons and ligaments in the projection of examined joints (total number - 54). Totally, 798 joints, 3078 entheses were examined. The study was conducted by US rheumatologist. Data collection: demographical, clinical, US (total synovitis count by grey scale, enthesitis counted as the sum of structural and acute components (US entheseal findings assessed by the definition and scoring for enthesitis in PsA (OMERACT US) 2 . Chi-square test used to calculate difference of articular and entheseal frequency between upper and lower extremities. 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, Disease Activity in PsA score 18.1 (10.2;26.1). Table. Frequency of articular and entheseal involvement of different anatomical sites in PsA Upper extremities / Joints / Entheses Frequency Lower extremities / Joints / Entheses Frequency Acromioclavicular 29/456 (6.4%) Hip 19/342 (5.6%) Shoulder 3/456 (0.7%) Knee 28/342 (8.2%) Elbow 10/456 (2.2%) Ankle 23/342 (6.7%) Wrist 27/456 (5.9%) Trochanter major: -gluteus minimum -gluteus medium 31/2166 (1.4%) 36/2166 (1.7%) Short head of the biceps brachii 11/912 (1.2%) Spina iliaca anterior -superior -inferior 13/2166 (0.6%) 8/2166 (0.4%) Coracoacromial ligament 5/912 (0.5%) Ischiadicus tuberositas 36/2166 (1.7%) Infrascapularis 19/912 (2.1%) Medial collateral ligament -Proximal -Distal 44/2166 (2%) 25/2280 (1.2%) Supraspinatus 18/912 (1.9%) Lateral collateral ligament -Proximal -Distal 23/2166 (1.1%) 9/2166 (0.4%) Infraspinatus 5/912 (0.5%) Patellar ligament -Proximal -Distal 19/2166 (0.9%) 25/2166 (1.2%) Triceps brachii 21/912 (2.3%) -Pes anserinus 37/2166 (1.7%) Medial epicondyle 21/912 (2.3%) Biceps femoris 7/2280 (0.3%) Lateral epicondyle 34/912 (3.7%) Semimembranosus 35/2166 (1.6%) Quadriceps femoris 52/2166 (2.4%) Tibialis anterior 9/2166 (0.4%) Tibialis posterior 13/2166 (0.6%) Achille 46/2166 (2.1%) Plantar fascia 30/2166 (1.4%) There was difference between US synovitis detection of upper (57,1%) and lower (42,9%) extremities (p=0.04). Total count of US enthesitis of lower extremities (70,4%) was significantly higher than of the upper (29,6%;p&lt;0.01). Conclusion: US synovitis of upper extremities was slightly higher than in lower. US enthesitis of lower extremities is significantly higher. US imaging can be used to diagnose enthesitis and synovitis, especially in patients in whom symptoms may be difficult to discern, and data on location of pathological lesions will be useful. References: [1]Perrotta FM, Astorri D, Zappia M, Reginelli A, Brunese L, Lubrano E. An ultrasonographic study of enthesis in early psoriatic arthritis patients naive to traditional and biologic DMARDs treatment. RheumatolInt 2016;36:1579-83. [2]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