POS1059 ULTRASOUND SYNOVITIS, UNLIKE ENTHESITIS OR CLINICAL JOINT ASSESSMENT, IS ASSOCIATED WITH JOINT DAMAGE PROGRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS
Authors: Y. Yamada, K. Inui, T. Okano, K. Mandai, K. Mamoto, T. Koike, C. Tateishi, D. Tsuruta, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2021)

Background: We previously reported that ultrasound assessment of enthesitis (US enthesitis) is not consistent with tenderness of the enthesis (clinical enthesitis) in patients with psoriatic arthritis (PsA). Although US enthesitis reflects inflammatory condition and clinical enthesitis is associated with disease activity and physical function, each of them was not associated with joint destruction by cross-sectional analysis1. It is reported that the utility of US for predicting joint destruction remains unclear among patients with PsA2. Objectives: This study is aimed to longitudinally investigate the relationships between enthesitis or synovitis and joint damage progression in patients with PsA. Methods: Forty-seven patients with PsA (average age of 56.5 years) underwent US and clinical examination of wrist and finger joints and 14 entheses (the bilateral humeral medial epicondyles and insertions of the triceps, distal quadriceps, proximal/distal patella, Achilles tendons, and plantar fascia). Tender or swollen joint count (TJC/SJC), Gray Scale (GS) and Power Doppler (PD) score of the joints, and US/clinical enthesitis counts were calculated. The relationships between the yearly progression in modified total sharp score (ΔmTSS) at two-time points (baseline and average follow-up of 20.4 months) and US or clinical findings were investigated. Results: ΔmTSS was significantly correlated with age (r=0.44, p=0.01), joint GS score (r=0.44, p=0.01), and joint PD score (r=0.38, p=0.03). TJC, SJC, inflammatory marker, and disease activity showed no associations with ΔmTSS. US/clinical enthesitis counts also showed no associations with ΔmTSS (Table 1). The joint PD score, adjusted by age, was significant factor for ΔmTSS by multiple regression analysis (b=0.50, p&lt;0.001). Conclusion: The joint PD score or US synovitis, unlike clinical joint assessment, was significant predictive factor for joint damage progression. It is important to assess joints by US as well as clinical examination. References: 1) Yutaro Yamada et al. Ultrasound assessment, unlike clinical assessment, reflects enthesitis in patients with psoriatic arthritis. Clin Exp Rheumatol. 2020 Apr 17. Online ahead of print. 2) van der Heijde et al. Assessing structural damage progression in psoriatic arthritis and its role as an outcome in research. Arthritis Res Ther. 2020, 22(1): 18. Table 1. Univariate analysis of predictive factors for joint damage progression in PsA patients. mTSS at baseline ΔmTSS R value p value R value p value age 0.55 &lt;0.001 0.44 0.01 PASE 0.04 0.81 0.12 0.52 PASI -0.25 0.15 -0.01 0.96 DAS28CRP -0.05 0.75 0.07 0.71 DAPSA -0.01 0.94 -0.01 0.97 HAQ 0.17 0.27 -0.07 0.73 CRP -0.13 0.38 0.23 0.20 MMP-3 0.04 0.80 0.29 0.12 biologics use 0.19 0.19 -0.11 0.54 Clinical enthesitis counts -0.01 0.97 -0.19 0.30 TJC -0.05 0.76 -0.10 0.58 SJC 0.21 0.18 0.13 0.48 US enthesitis counts 0.12 0.44 -0.13 0.48 joint GS score 0.08 0.60 0.44 0.01 joint PD score 0.08 0.60 0.38 0.03 PsA: psoriatic arthritis, mTSS: modified Total Sharp Score, PASE: Psoriatic Arthritis Screening and Evaluation, PASI: Psoriasis Area Severity Index, DAPSA: Disease Activity in Psoriatic Arthritis, DAS: Disease Activity Score, CRP: C-reactive protein, HAQ: Health Assessment Questionnaire, MMP-3: matrix metalloproteinase 3, TJC: tender joint counts, SJC: swollen joint counts, GS: Gray Scale, PD: Power Doppler Disclosure of Interests: Yutaro Yamada: None declared, Kentaro Inui Speakers bureau: Abbvie, Eisai, Eli Lilly, Grant/research support from: Abbvie, Eisai, Chigai, Eli Lilly, Daiichi Sankyo, Mitusbishi Tanabe, Pfizer, UCB, Tadashi Okano Speakers bureau: Abbvie, Koji Mandai: None declared, Kenji Mamoto: None declared, Tatsuya Koike Grant/research support from: Abbvie, Chugai, Chiharu Tateishi: None declared, Daisuke Tsuruta Speakers bureau: Abbvie, Astellas, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Novartis, Sanofi, Grant/research support from: Abbvie, Eli Lilly, Bristol-Myers Squibb, UCB, Hiroaki Nakamura Grant/research support from: Astellas, Asahi Kasei