Severity of sonographic enthesitis seen as a marker of joint damage in PsA

MADRID — Severe enthesitis on sonography was associated with radiographic peripheral and axial joint damage in patients with psoriatic arthritis, according to a study presented at the EULAR Annual Congress.

“Investigating enthesitis in patients with psoriatic arthritis [PsA] could potentially improve our understanding of the underlying mechanisms of psoriatic arthritis, but the clinical assessment of enthesitis is limited,” presenter Lihi Eder, MD, PhD, said in a press conference.

In the cross-sectional study, researchers evaluated 222 consecutive patients (mean age: 55.9; 58% were men) with PsA. The researchers used the Madrid Sonography Enthesitis Index (MASEI) scoring system to quantify the degree of sonographic irregularities in 12 enthenesal locations. The total MASEI score was further divided into bone scores (enthesophytes, erosions) and soft tissue scores (changes in structure, vascularization and bursitis). The researchers evaluated radiographic joint damage independent of the ultrasound results using the modified Steinbrocker score, the Modified New York Criteria for sacroiliitis and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). All cases were also assessed for the presence of ankylosis, arthritis mutilans, and periostitis in the hands and feet. After controlling for age, gender, BMI, duration of PsA and use of medications, the researchers used linear regression models to evaluate the association between MASEI score and radiographic signs of joint damage. The researchers found that the mean MASEI score was 15.6 (±12.6) and the mean modified Steinbrocker score was 18.1 (±32.3) The mean mSASSS was 1.7 (7.3) and sacroiliitis was present in 37% of patients. On multivariate analysis, the researchers identified an association between higher MASEI scores and the following: peripheral joint damage; modified Steinbrocker score joint ankylosis (odds ratio [OR] = 2.09); and arthritis mutilans (OR = 1.73). There was a borderline statistically significant correlation between MASEI scores and periositis (OR = 1.29). Likewise, multivariate analyses found an association between higher MASEI scores and axial damage as assessed by mSASSS and sacroiliitis (OR = 1.36). Analysis of the subcategories of MASEI score found a stronger association between radiographic damage and MASEI bone score than between radiographic damage and MASEI soft tissue score.“We found that enthesitis is associated with peripheral and axial radiographic joint damage in patients with PsA,” Eder said in the press conference. “This association tended to be strong with features of entheseal bone damage compared with soft-tissue enthesitis.”

Reference:

Eder L, et al. Abstract # OP0111. Presented at: EULAR Annual Congress; June 14-17, 2017; Madrid.

Disclosure: The researchers report no relevant disclosures.