OP0253 COMPARISON OF MUSCULOSKELETAL ULTRASOUND SIGNAL CHANGES IN PSORIASIS PATIENTS, WITHOUT OR UNDER SUSPICION OF PSORIATIC ARTHRITIS, BEFORE AND AFTER PHYSICAL EXERTION WITH DYNAMOMETER: AN EXPLORATORY, CONTROLLED, CROSS-SECTIONAL, MULTICENTRE STUDY
Authors: C. A. Guillén-Astete, M. Ahijón Lana, J. C. Nieto González, A. Lois-Iglesias, M. Vázquez Díaz
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Musculoskeletal ultrasound is a non-invasive imaging method that identifies synovial and entheseal involvement in spondyloarthritis. In patients with psoriatic arthritis (PsA) in clinical remission, ultrasound signs of tenosynovial and entheseal inflammation have been observed after exposure to physical exertion. In isolated observations, these same findings have been identified in patients with psoriasis (PsO) who do not meet classification criteria for PsA. Formal demonstration of this phenomenon would allow a better understanding of psoriatic disease and its potential evolution into a joint form. <h3>Objectives:</h3> The aim of this study was to identify the existence of tendon, synovial and/or entheseal inflammatory changes by ultrasound after performing a manual exercise with a handheld dynamometer, in patients with PsO under suspicion of PsA, based on the PsA screening questionnaire (PURE4), comparing patients without suspected PsA and healthy controls; and to explore factors associated with a greater chance of change in the ultrasound score of synovitis and enthesitis. <h3>Methods:</h3> National, multicentre, exploratory, and cross-sectional study, based on data of patients enrolled from July 2022 to June 2023 (Figure 1). Patients ≥18 and ≤50 years, with active PsO, referred from the Dermatology to the Rheumatology department, under PsA suspicion (PURE4≥1) or without PsA suspicion (PURE4&lt;1), were included. Patients with a previous diagnosis of PsA or any rheumatic disease (fulfilling the ClASsification criteria for Psoriatic ARthritis -CASPAR- criteria or not), and/or with regular or recent use of non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, were excluded. Controls with no history of known joint disease are included, matched by age and sex to the patients. <h3>Results:</h3> Overall, 373 participants (295 healthy subjects and 78 PsO patients) were enrolled at 3 Spanish hospitals. Participants had a mean (standard deviation, SD) age of 35.2 (9.37) and 40.72 (8.96) years in the control and PsO patients' groups, respectively, and the median (Maximum, Max; Minimum, Min) time since diagnosis was 146.9 (0, 546.8) months. A total of 55.1% and 30.8% of the patients had a history of PsO treatment with topical and systemic therapies, respectively. Finally, 5.1% and 28.2% of the patients had history of dactylitis and nail PsO, respectively. The changes of all three combined scores (synovitis, tenosynovitis, enthesitis) differed significantly among groups for each score, and the comparison between the control group and the PsO patients' group (PURE4&lt;1: without PsA suspicion, and PURE4≥1: under PsA suspicion) were also statistically significative for each score (p&lt;0.0005) (Figure 2). However, there were no significant differences between the two patient groups. The relative frequencies of increases for the combined tenosynovitis and enthesitis scores by groups were statistically significant (p&lt;0.0005). Both combined scores were higher in the group PURE4 &lt;1 (without PsA suspicion), although the difference was only significant for enthesitis (p=0.033). Regarding the association of the categorical clinical variables with each of the combined score changes, a slight positive correlation was obtained between age and enthesitis score change for overall PsO patients, although not by patients' groups separately. The history of psoriasis treatment was found significantly associated with synovitis and tenosynovitis combined scores, for all patients of both PsO groups. In the case of the group PURE4≥1 (under PsA suspicion) a significant association was also found for tenosynovitis combined score and the history of psoriasis treatment. No significant associations with none of the score changes were found for the other clinical variables. <h3>Conclusion:</h3> The PsO patients showed a higher proportion of synovial, tenosynovial, and enthesis hyperresponsiveness measured by ultrasound assessment after dynamometric exertion than healthy subjects. Moreover, this hyperresponsiveness would not be independently related to other clinical variables, except for the history of psoriasis treatments. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> The present study was funded by Novartis. <h3>Disclosure of Interests:</h3> Carlos A. Guillén-Astete Novartis, Janssen, ROCHE, Abbvie, UCB, Galápagos, Novartis, Jannsen, Abbvie, UCB, Grünental, Galápagos, Janssen, Galápagos, Novartis, Pfizer, Novartis, María Ahijón Lana: None declared, Juan Carlos Nieto González MSD, Abbvie, Galápagos, Pfizer, Sandoz, Galápagos, Abbvie, Pfizer, Ana Lois-Iglesias: None declared, Mónica Vázquez Díaz Galápagos, Abbvie, Pfizer, Galápagos, Abbvie, Pfizer, Pfizer, Novartis.