Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity.
OBJECTIVE
To investigate the association between clinical and ultrasonographic (US) evidence of inflammation in psoriatic arthritis (PsA), as well as to compare clinical and US remission criteria.


METHODS
In this cross-sectional study 141 PsA outpatients were included. Minimal disease activity (MDA), 28-joint Disease Activity Score (DAS28), Disease Activity Index for PSoriatic Arthritis (DAPSA) and modified versions of Composite Psoriatic Disease Activity Index (CPDAI) and Psoriatic ArthritiS Disease Activity Score (PASDAS) were assessed. Remission criteria were explored. US evaluation was performed on 34 joints, in addition to joints being tender/swollen by 66/68 joint count, 30 tendons, 10 entheses and additionally entheses found to be tender by clinical examination of 19 other entheses. Power Doppler (PD) and grey scale global scores on joints, entheses and tendons were assessed. US remission was defined as no PD activity in joints, entheses and tendons.


RESULTS
DAPSA and DAS28, but not CPDAI and PASDAS, were associated with PD activity. MDA was fulfilled in 22.7% and the clinical remission criteria in 5.7%-9.9% of the patients. US remission was found in 49.6% of the patients. The prevalence of PD activity at joints, entheses and tendons was similar for patients fulfilling versus not fulfilling MDA/clinical remission criteria. MDA (OR 2.3, p=0.048), DAPSA ≤3.3 (OR 4.2, p=0.025) and Boolean's (OR=7.8, p=0.033) definitions of remission were found to predict US remission.


CONCLUSIONS
We found major discrepancies between US and clinical findings. DAPSA and DAS28 reflected US findings better than CPDAI and PASDAS. MDA, DAPSA and Boolean's remission criteria predicted US remission.
Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.
Brigitte
B
Michelsen
Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.|Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway.
Andreas P
AP
Diamantopoulos
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Hilde B
HB
Hammer
Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.
Dag M
DM
Soldal
Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, USA.
Arthur
A
Kavanaugh
Department of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.
Glenn
G
Haugeberg
D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012074:Remission Induction; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods
Disease Activity; Psoriatic Arthritis; Ultrasonography