title: Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage.
abstract: This study aims to identify the clinical predictors of arthritis in patients with psoriasis and to evaluate the use of musculoskeletal ultrasonography (US) as a predictor for inflammatory structural progression in psoriatic patients. Measures of association (odds ratio (OR)) were tested, in a prospective, cohort 1-year follow-up study, between structural deterioration and the presence of baseline inflammation, or its persistence. One hundred twenty-six psoriatic patients were prospectively evaluated both clinically and by US at 0, 6, and 12 months for synovitis/ joint damage, enthesitis, and onychopathy. X-ray was performed at 0 and 12 months. One hundred twelve sex and age-matched pasoriatic patients without histories of musculoskeletal symptoms were included as control group. Structural deterioration was observed in 47% of the 5,292 evaluated joints. Clinical variables associated with arthritis risk: BMI > 25 (OR = 1.7), body surface area (OR = 1.13), family history (OR = 5.72) and nail involvement (OR = 2.25). BMI > 30 was significantly correlated (P < 0.01) with shorter time for the onset of arthritis. Baseline synovial score/PD score ≥ 2 was associated with increased risk of structural progression: OR = 1.98 versus 2.61 versus 2.66 (P < 0.001) for the clinical versus US-gray scale (GS) versus US-power Doppler (PD) evaluation, respectively. An increased probability for structural progression in the presence of enthesitis was observed (OR = 2.79 and 3.50) for both US-GS and US-PD, whereas OR was 2.46 for clinical examination. Onychopathy was associated with structural joint damage (OR = 2.30). In multivariate logistic regression analysis, persistent of synovitis/enthesitis at 6 months of therapy was predictive of subsequent structural progression. Family history of psoriatic arthritis, large BMI (>25), high percentage of psoriatic body surface area, and nail involvement were significantly associated with early onset psoriatic arthritis. Baseline GS score of ≥2, PD score of ≥2, presence of enthesitis, enhanced vascularity at enthesitis, higher GUESS score, and onychopathy, all at base line as well as persistent synovitis and enthesitis at 6 months are predictors of progressive early psoriatic arthritis. Regular ultrasonographic monitoring of these patients is mandatory to assess the progression of their arthritis status.
authors.affiliation: Darent Valley Hospital, Dartford, Kent, UK, drelmiedany@rheumatology4u.com.
authors.forename: Yasser
authors.initials: Y
authors.lastname: El Miedany
authors.forename: Maha
authors.initials: M
authors.lastname: El Gaafary
authors.forename: Sally
authors.initials: S
authors.lastname: Youssef
authors.forename: Ihab
authors.initials: I
authors.lastname: Ahmed
authors.forename: Annie
authors.initials: A
authors.lastname: Nasr
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000000981:diagnostic imaging*; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging; D013585:Synovitis / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult