POS0265 CLINICAL AND ULTRASONOGRAPHIC ENTHESITIS IN INFLAMMATORY BOWEL DISEASE WITH AND WITHOUT PSORIASIS
Authors: G. Citriniti, A. Soriano, E. Bertolini, G. Sandri, A. Bertani, I. Tinazzi, F. Martinis, N. Girolimetto, C. Salvarani, M. Beltrami, P. Macchioni
Journal: Annals of the Rheumatic Diseases (2021)

Background: Previous studies have reported an association between psoriasis (PsO) and inflammatory bowel disease (IBD). Coexistence of IBD and PsO has been associated with significant higher prevalence of enthesitis and dactylitis 1 . Objectives: To compare the prevalence of clinical and ultrasonographic peripheral enthesis abnormalities in a consecutive series of patients with IBD and psoriasis (PsO) as compared to a group of IBD patients without psoriasis (IBD). Methods: One-hundred seventy-four IBD consecutive patients [36 PsO and 138 IBD, M/F 91/83, mean age 42.6±14.7 years, mean disease duration 110 ±12.3 months] entered the study. A complete clinical examination, including rheumatological history, 66/68 peripheral joint count, MASES and LEI scores, BASDAI, and dactylitis count, was performed at study entry. Laboratory test (ESR, CRP, Hb, fecal calprotectin) were collected. Axial or peripheral SpA diagnosis was made using ASAS criteria 2 . US examination was executed by a rheumatologist blind to clinical data, using an Esaote MyLabClass, 18-6MHz linear multifrequence transducer both in B-mode and PD-mode. The following sites were examined bilaterally: lateral epicondyle of the humerus, distal quadriceps femoris insertion into the patella, inferior pole of the patella, tibial distal insertion of the patellar tendon, calcaneal insertion of the Achilles tendon, and plantar aponeurosis insertion. Knee and ankle joints were evaluated for synovial hypertrophy, PD signal and fluid effusion. Enthesitis was defined according to OMERACT 3 and scored as 0-36 for GUESS and 0-136 for MASEI. Results: PsO patients had later IBD onset (mean age 39±14.7 vs 33 ± 13.2 in IBD group, p=0.02). There weren’t observed any significant differences in IBD duration and Crohn/UC prevalence. No significant difference between the two groups in rheumatological history and clinical examination was detected, except for familiar history of psoriasis (PsO 44% vs IBD 16%, p &lt;0.001). Prevalence of SpA was 33,3% in PsO group and 37% in IBD group (p = 0.687). 146 patients (83.4%) showed structural damage at ≥ 1 enthesis, 44 patients (25%) had at least 1 active enthesitis, with no significant difference between the two groups. PsO group showcased a significantly increased prevalence of patients having ≥ 1 thickened enthesis (86.1% vs 63.9%, p=0.009) and of PD signal at knee examination (11.1% vs 2.2%, p= 0.034). Higher values of GUESS score were observed in PsO (8.1±5.1 vs 5.8±3.9, p=0.017). Enthesis hypoechogenicity was more prevalent in IBD group (27.5% vs 11.1%, p=0.049). Enthesis thickness was significantly increased in PsO, in every examined site. Enthesophyte length was significantly increased in PsO group at quadriceps tendon, patellar distal insertion and Achilles tendon. Conclusion: No differences in clinical manifestation and rheumatological history between IBD and PsO patients were observed. Subclinical (US) abnormalities were significantly increased in IBD patients with associated PsO, as compared to patients affected by IBD. References: [1]Cantini, F. et al. J. Rheumatol. 44 , 1341–1346 (2017). [2]Rudwaleit, M. et al. Ann. Rheum. Dis. 68 , 777–783 (2009). [3]Balint, P. V. et al. Ann. Rheum. Dis. 77 , 1730–1735 (2018). Acknowledgements: Abbvie provided funding for medical writing Disclosure of Interests: Giorgia Citriniti: None declared, Alessandra Soriano: None declared, Elena Bertolini: None declared, Gilda Sandri: None declared, Angela Bertani: None declared, Ilaria Tinazzi: None declared, Federica Martinis: None declared, Nicolò Girolimetto: None declared, Carlo Salvarani: None declared, Marina Beltrami Grant/research support from: Abbvie provided funding for medical writing, Pierluigi Macchioni: None declared