AB0950 Detection of asymptomatic entheseal involvement in patients with psoriasis: A case-control ultrasound study

Abstract

BackgroundEnthesopathy is one of the major features of psoriatic arthritis (PsA). The clinical screening for enthesopathies and synovitis in patients with psoriasis is nonspecific during the subclinical phase. Ultrasonography (US) has already demonstrated its ability to study entheses and joints in early stages of PsA.ObjectivesTo evaluate the prevalence of ultrasonographic subclinical synovitis and enthesopathies in psoriasis patients with no clinical evidence of PsA compared with controls.MethodsA cross-sectional study conducted on 40 patients with psoriasis and 40 healthy sex- and age- matched controls. The Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada (SPARCC) were used to evaluate entheseal involvement. US examination of 18 joints (wrists, metacarpophalangeal, and proximal interphalangeal joints) was performed along with 22 entheseal sites (deep flexor of the fingers, lateral epincondyle, triceps, quadriceps, patellar and calcaneal tendons and plantar fascia). Inflammatory-score (thickening, hypoechogenocity, bursitis and Doppler signal) and damage-score (calcifications, enthesophytes and erosions) were calculated (0= absent, 1=present for each abnormality). A total-score was obtained by adding these two scores.ResultsThe mean age of psoriatic patients 51,90±15,90 [19 -76] and the sex ratio of males to females was 3:2. US synovitis were more frequent in psoriatic patients 7/1040 (0,68%) than in controls 3/1040 (0,29%) but this was not significant (p= 0,420). Patients with psoriasis had more US enthesopathies 37 (92,5%) comparing to controls 16 (40%) (p < 0,001). The total number of enthesopathies was higher in the psoriatic group 184/880 (20,90%) comparing to controls 42/880 (4,78%) (p < 0,001). Entheses with more US abnormalities in the psoriasis group comparing to controls were deep flexor tendons of the fingers entheses (p<0,001), distal patellar tendon entheses (p<0,001) and calcaneal tendon entheses (p<0,001). LEI and SPARCC scores were positively correlated to higher number of US enthesopathies (p=0,046, p=0,006). SPARCC was positively correlated to inflammatory-score and damage-score (p=0,009, p=0,024). The mean C-reactive protein level was higher in psoriatic arthritis 5,77±10,10 mg/L than in controls 2,15±3,26mg/L (p=0,037).ConclusionOur results confirm that US enthesopathies and synovitis are more frequent in patients with psoriasis comparing to healthy population. The US screening for subclinical enthesopathies should be the object of longitudinal investigations to define its value in predicting the clinical onset of PsA.Disclosure of InterestsNone declared