Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers

Objectives: We aimed to describe sonographic structural and inflammatory changes in entheses of patients with recently diagnosed psoriatic arthritis (PsA), patients with established PsA, and young healthy volunteers, and to investigate whether the MAdrid Sonographic Enthesitis Index (MASEI) enables us to distinguish these groups in an extreme comparison. Method: New and established PsA patients and healthy volunteers (aged 20–30 years) were recruited. The triceps, quadriceps, patellar, Achilles and elbow extensor tendon insertion, and plantar fascia entheses were investigated sonographically for structural changes, erosions, calcifications, increased thickness, bursitis, and power Doppler (PD) signal according to the MASEI. Results: The study included 25 new and 25 established PsA patients, and 25 healthy volunteers. Increased thickness and PD signal in knee entheses were common for patients and healthy volunteers, while changes at other locations predominantly occurred in patients only. PD was recoded (1, one spot; 1.5, two or three spots; 2, confluent signal; 3, severe confluent signal) and thickness of knee entheses excluded. This resulted in different modified MASEI scores between PsA patients and young healthy controls: median (interquartile range) modified MASEI of 13 (10–22.5) in new PsA, 13.5 (9.5–18) in established PsA, and 3 (1–8.5) in healthy volunteers (p = 0.002). Conclusions: Structural ultrasound changes and PD in entheses are common in both new and established PsA and healthy controls. MASEI score did not differentiate PsA patients from young healthy volu

Measuring Disease Activity and Outcomes in Early Psoriatic Arthritis

Psoriatic Arthritis (PsA) is a heterogeneous disease, characterized by manifestations of peripheral arthritis, dactylitis, enthesitis, spondylitis, and psoriasis. Patients with PsA experience the impact of disease as loss of functional ability, decreased health-related quality of life (HRQOL) and loss of productivity. Treatment is aimed at preventing these consequences. It is recommended that treatment is given as early as possible, with all manifestations taken into account, and in a treat-to-target strategy. In a treat-to-target strategy, treatment is intensified if a certain target – a composite disease activity measure – has not been achieved. Good measures of disease activity are needed to improve outcomes for patients with PsA. For this purpose, more information is needed on disease activity and outcomes early in the disease course. These are studied in the Dutch southwest Early Psoriatic Arthritis cohoRt (DEPAR) and related sub-studies. This thesis aims to investigate the following four aspects of disease activity and outcomes in early PsA: ultrasound abnormalities of the entheses, burden of disease at time of diagnosis and its relation with disease manifestations, the relation between time to minimal disease activity and outcomes, and the performance of disease activity measures

Evaluación Ecográfica del Compromiso de Entesis en Pacientes con Espondiloartritis

La entesis es el órgano diana de la inflamación en las espondiloartritis (EspA) siendo clave en su fisiopatogenia. La ecografía está emergiendo como la técnica de preferencia para la detección de entesitis. Se realizó este estudio a fin de describir las características ecográficas del compromiso de las entesis en pacientes con espondiloartritis. Se evaluaron 20 pacientes con diagnóstico de EspA que acudieron al Hospital de Clínicas. Se investigaron variables clínicas y demográficas y posteriormente exploración ecográfica en 12 sitios de entesis hallándose los índices GUESS (Glasgow Enthesitis Scoring System) y MASEI (Madrid Sonographic Enthesitis Index) y posterior correlación de las variables ecográficas con las clínicas.CONACYT - Consejo Nacional de Ciencia y TecnologíaPROCIENCI

Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo:cohort studies in the UK and Denmark

The pathogeneses of skin diseases are not fully understood. Psychological stress has been proposed to be associated with skin diseases, but the epidemiological evidence is limited [1, 2]. We have recently reported the associations between partner bereavement (an extreme life stressor) and psoriasis, atopic eczema and melanoma [3, 4]. In this study, we further investigated whether partner bereavement was associated with urticaria, alopecia areata, or vitiligo

La utilidad de la ultrasonografía como herramienta diagnóstica para detectar artritis psoriásica en pacientes con psoriasis

El objetivo de nuestro estudio fue evaluar la prevalencia de entesopatía subclínica en pacientes con psoriasis cutánea (Ps) utilizando un score ultrasonográfico (US) como herramienta diagnóstica en la práctica diaria y evaluar la habilidad de dicho score para discriminar pacientes con Ps y Artritis Psoriásica (APs)

Ultrasound Imaging in Psoriatic Arthritis: What Have We Learnt in the Last Five Years?

Psoriatic arthritis (PsA) is a complex heterogeneous disease with multiple inter-related pathologies such as synovitis, enthesitis, tendinopathy, and dactylitis. Clinical assessment is limited in its detail to assess pathology, thus in recent years, ultrasound (US) has become more popular, given its high sensitivity to detect inflammatory arthritis and ability to inform clinical decisions. Although a qualitative technique, US findings can be graded semi-quantitatively for grayscale (GS) and power Doppler (PD). Synovitis is frequently present in inflammatory arthritis pathologies, and in PsA, recent evidence shows a propensity for tendon and entheseal lesions. The presence of flexor tenosynovitis and flexor tendon insertional enthesopathy at accessory pulleys is supportive of the “Deep Koebner” concept. Peri-tendinous inflammation—mutual to PsA or rheumatoid arthritis (RA), is associated with soft tissue oedema with PD signal frequently at the flexor tendon compartments in PsA. Research on enthesitis in PsA/PsO has improved understanding in subclinical and clinical PsA, explored associations with progression to PsA, and investigated links to prognosis assessment. Dactylitis is a pathognomonic PsA lesion where US has enhanced knowledge of the disease course and pathology of lesions such as: flexor tenosynovitis; synovitis; and soft tissue oedema. Increased US sensitivity has also brought innovation including promising automated ultrasound scanning techniques. So, what have we learnt in recent years and what are the unmet needs to focus future research initiatives in this disabling disease? This narrative review article assesses the neoteric evidence, bringing into context the knowledge gained and highlighting potential areas of research

Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis:protocol for a prospective, exploratory cohort study

INTRODUCTION: Persistent pain is a major concern for patients with psoriatic arthritis (PsA). Pain may be due to inflammatory activity or augmented central pain processing. Unawareness of the origin and mechanisms of pain can lead to misinterpretation of disease activity (by composite scores) and erroneous treatments. Ultrasonography (US) is a highly sensitive method to detect tissue inflammation. Evaluating pain mechanisms in relation to US measures may prove valuable in predicting response to treatment in PsA. AIMS: To study the association and prognostic value of pain mechanisms, ultrasonic activity and clinical outcomes in patients with PsA who intensify antirheumatic treatment. METHODS AND ANALYSES: 100 participants >18 years of age with PsA who initiate or switch antirheumatic treatment (biologicals and/or conventional synthetic disease-modifying antirheumatic drugs (DMARDs)) will be prospectively recruited from outpatient clinics in Copenhagen. All data (demographics, clinical, imaging, blood samples and patient-reported outcomes) will be collected at baseline and after 4 months. Pain is assessed by the PainDETECT Questionnaire, Visual Analogue Scale for pain, Swollen to Tender Joint Count Ratio, Widespread Pain Index and tender point examination. The association between pain variables and clinical/US characteristics will be described by correlation analyses. The predictive value of pain measures and baseline US scores on treatment response will be analysed with regression models. Outcomes are composite and clinical, as well as patient reported. ETHICS AND DISSEMINATION: The study is approved by the ethics committee of the Capital Region of Denmark (H-15009080) and has been designed in cooperation with patient research partners. The study is registered at clinicaltrials.gov (number NCT02572700). Results will be disseminated through publication in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02572700, Pre-results

Entezitis as a predictor of the manifestation of psoriasis arthritis

Psorijaza je autoimunska sistemska inflamatorna bolest, čija je učestalost u opštoj populaciji oko 2-3%. Pored promena na koži, bolesnik sa psorijazom je sa povišenim rizikom za pojavu depresije, gojaznosti, dijabetesa, inflamatornih bolesti creva, hipertenzije, bolesti srca. Najčešći komorbiiditet psorijaze je psorijazni artritis (PsA). Entezitis je jedan od tri ključna klinička znaka PsA. Metode. Biće sprovedena prospektivna studija (studija slučaj-kontrola) kojom će biti obuhvaćeno 180 pacijenata obolelih od psorijaze (patohistološki verifikovane), koji nisu lečeni sistemskom terapijom, izuzev uskospektralne UVB fototerapije ili PUVA terapije. Ovim bolesnicima će biti izveden ultrasonografski pregled enteza i kalkulacija MASEI i GUESS skora, procena kvaliteta života kroz Dermatološki indeks kvaliteta života (DLQI), popunjavanje i poređenje upitnika za procenu rizika psorijaznog artritisa. Biće registrovani demografski i podaci o dosadašnjem toku i trenutnoj aktivnosti bolesti (PASI skor), podaci o komorbiditetima. Ultrasonografski pregledi enteza biće izvedeni u Institutu za radiologiju Vojnomedicinske akademije u Beogradu, na ultrazvučnom aparatu Resona 7 firme Mindray. Biće korišćena ultrazvučna sonda L14-6WU. Očekivani rezultati. Prisustvo entezitisa na osnovu ultrasonografskog pregleda enteza može imati prediktivnu vrednost za ispoljavanje psorijaznog artritisa i utiče na kvalitet života kod bolesnika sa psorijazom, upitnici za procenu rizika od psorijaznog artritisa mogu pružiti dodatne validne informacije, pojedini klinički parametri (trajanje i aktivnost psorijaze) i stepen sistemske inflamacije mogu imati prediktivnu vrednost za ispoljavanje psorijaznog artritisa i uticati na kvalitet života kod bolesnika sa psorijazom. Prisustvo komorbiditeta (pogotovu na lokomotornom sistemu), stepen depresije i subjektivna interpretacija bola mogu imati negativnu prediktivnu vrednost za ispoljavanje psorijaznog artritisa. Očekivani zaključak. Na osnovu dobijenih rezultata zaključićemo da ultrasonografski pregled enteza predstavlja značajan korak u skrinigu pacijenata sa psorijazom. Subjektivni parametri dobijeni preko upitnika za skrining bolesnika sa psorijazom imaju određeni, ali manji značaj u odnosu na objektivni ultrasonografski pregled.Psoriasis is an autoimmune systemic inflammatory disease, with a prevalence of about 2-3% in the general population. In addition to skin changes, a patient with psoriasis is elevated risk of depression, obesity, diabetes, inflammatory bowel disease, hypertension, heart disease. The most common comorbidity of psoriasis is psoriatic arthritis (PsA). Entezitis represents one of the three key clinical signs of PsA. Methods. A prospective study (case-control study) will be conducted to cover 180 patients with psoriasis (histopathologically verified) who have not been treated with systemic therapy, except for narrow-spectrum UVB phototherapy or PUVA therapy. These patients will undergo an ultrasonographic examination of the enthesis and calculations of MASEI and GUESS scores, assessment of quality of life through the Dermatological Quality of Life Index (DLQI), completing and comparing the psoriasis arthritis risk assessment questionnaire. Demographics and data on the existing and current activity of the disease will be registered (PASI score), comorbidities data. The ultrasonographic examinations of the enthesis will be performed at the Institute of Radiology of the Military Medical Academy in Belgrade, using the Mindray ultrasound device Resona 7. An L14-6WU ultrasonic probe will be used. Expected results. The presence of enthesitis based on an ultrasonographic examination of the enthesis may have predictive value for the manifestation of psoriatic arthritis and affect the quality of life in patients with psoriasis, psoriatic arthritis risk assessment questionnaires may provide additional valid information, individual clinical parameters (duration and activity of psoriasis) and degree of systemic inflammation may be predictive for manifestation of psoriatic arthritis and affect quality of life in patients with psoriasis. Presence of comorbidities (especially on the locomotor system), degree of depression and subjective interpretation of pain may have negative predictive value for the manifestation of psoriatic arthritis. Expected conclusion. Based on the results obtained, we will conclude that an ultrasonographic examination of the enthesis represents a significant step in the screening of patients with psoriasis. Subjective parameters obtained through the screening questionnaire for patients with psoriasis have certain, but less significance compared to objective ultrasonographic examination