SAT0439 POWER DOPPLER ULTRASOUND ASSESSMENT OF A1 PULLEY. A NEW TARGET IN PSORIATIC ARTHRITIS?
Authors: G. Smerilli, E. Cipolletta, M. DI Carlo, A. DI Matteo, W. Grassi, E. Filippucci
Journal: Annals of the Rheumatic Diseases (2020)

Background: In the last few years annular pulleys inflammation has been highlighted as a possible key pathogenetic factor in psoriatic dactylitis, first with magnetic resonance imaging (MRI) 1 , then, in a very recent paper 2 , with power Doppler (PD) ultrasound (US). However, the prevalence of PD US inflammation of annular pulleys in psoriatic arthritis (PsA) patients compared to rheumatoid arthritis (RA) patients has not been investigated yet. Objectives: To determine the prevalence of PD US findings indicative of A1 pulley inflammation in PsA patients and in controls with RA and to preliminarily investigate the correlation between A1 pulley inflammation and disease activity (DAPSA). Methods: Consecutive patients with PsA and RA were included in this cross-sectional single-centre study. A rheumatologist recorded demographic and clinical data and in the same day another rheumatologist performed the US examination using a MyLab ClassC (Esaote, Genova, Italy) equipped with a 10-22 MHz linear probe. A1 pulleys of fingers 2 nd to 5 th were assessed bilaterally adopting longitudinal and transverse scans. The following pathological US findings were recorded: inflammation of the pulley (defined as the presence of PD signal within a thickened pulley) and tenosynovitis of the digital flexor tendons at finger level according to OMERACT definition. Results: Sixty patients were enrolled: 30 with PsA and 30 with RA. Inflammation of A1 pulley was found in 15 out 240 fingers (6.3%) of 8 (26.7%) PsA patients and in 1 out of 240 fingers (0.4%) of 1 (3.3%) RA patients (p&lt;0.01 and p=0.03 respectively). Both pulley inflammation and tenosynovitis were correlated with DAPSA (Rpb=0.56, p&lt;0.01 and Rpb=0.48, p&lt;0.01). In fact, 7 out 8 (88%) PsA patients with at least one inflamed A1 pulley had a moderate/high disease activity score. The regression linear analysis (R2=0.36, adjusted R2=0.31) showed that A1 pulley inflammation was correlated with higher DAPSA scores (β=0.43, p=0.03). No significant association was reported between A1 pulley inflammation and past or current episodes of dactylitis (p=0.09). However, the only current dactylitis assessed showed A1 pulley inflammation. Conclusion: This pilot study demonstrated that ultrasound A1 pulley inflammation, defined as the presence of power Doppler signal within a thickened pulley, is relatively common at patient level in psoriatic arthritis and seems to be characteristic of PsA compared to RA. In psoriatic arthritis patients, a positive significant correlation was found between ultrasound A1 pulley inflammation and disease activity. References: [1]Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 2015; 74: 185-9. [2]Tinazzi I, McGonagle D, Macchioni P, Aydin SZ. Power Doppler enhancement of accessory pulleys confirming disease localization in psoriatic dactylitis. Rheumatology (Oxford) 2019 [Epub ahead of print]. Disclosure of Interests: Gianluca Smerilli: None declared, Edoardo Cipolletta: None declared, Marco Di Carlo: None declared, Andrea Di Matteo Grant/research support from: the publication was conducted while Dr. Di Matteo was an ARTICULUM fellow, Walter Grassi Speakers bureau: Prof. Grassi reports personal fees from AbbVie, personal fees from Celgene, personal fees from Grünenthal, personal fees from Pfizer, personal fees from Union Chimique Belge Pharma, outside the submitted work., Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work.