Psoriatic arthritis: Lessons from imaging studies and implications for therapy.

Introduction: Modern imaging may aid in the diagnosis, prognosis and monitoring of therapeutic response in psoriatic arthritis (PsA). Detection of osteitis and technical advances like whole body magnetic resonance imaging (MRI) exemplify the value of this technology. Areas covered: Ultrasound (US) provides a clinic-based tool for evaluating both joint pathologies and extra-articular structures (especially enthesitis) including skin and nail disease. Recent studies have demonstrated subclinical disease in psoriasis without arthritis, as well as in PsA, with implications for diagnosis and treatment classification. Modern imaging can also facilitate decisions on tapering of expensive biologics, though real-world clinical studies are still lacking. Expert commentary: The increase in novel PsA therapies should increase the utilization of modern imaging, providing both increased validation of imaging biomarkers as well as responsive outcome measures

Monitoring total-body inflammation and damage in joints and entheses: the first follow-up study of whole-body magnetic resonance imaging in rheumatoid arthritis

<p><b>Objective</b>: To investigate changes in whole-body magnetic resonance imaging (WBMRI) inflammatory and structural lesions in most joints and entheses in patients with rheumatoid arthritis (RA) treated with adalimumab.</p> <p><b>Methods</b>: WBMRI was obtained at weeks 0, 6, 16, and 52 in a 52 week follow-up study of 37 RA patients starting treatment with adalimumab. Readability and reliability of WBMRI were investigated for 76 peripheral joints, 23 discovertebral units, the sacroiliac joints, and 33 entheses. Changes in WBMRI joint and entheses counts were investigated.</p> <p><b>Results</b>: The readability of peripheral and axial joints was 82–100%, being less for elbows and small joints of the feet. For entheses, 72–100% were readable, except for entheses at the anterior chest wall, elbow, knee, and plantar fascia. The intrareader agreement was high for bone marrow oedema (BMO), bone erosion (80–100%), and enthesitis (77–100%), and slightly lower for synovitis and soft tissue inflammation (50–100%). All synovitis, BMO, and soft tissue inflammation counts decreased numerically during treatment. The 26-joint synovitis WBMRI count decreased significantly during the first 16 weeks for patients with a good European League Against Rheumatism (EULAR) response (from median 6 to 4, p < 0.05), but not for patients with a moderate or no EULAR response. There were no overall changes in structural lesions.</p> <p><b>Conclusions</b>: WBMRI allows simultaneous monitoring of most axial and peripheral joints and entheses in RA patients and can visualize a decrease in inflammatory counts during treatment. This first WBMRI follow-up study of patients with RA encourages further investigation of the usefulness of WBMRI in RA.</p

The OMERACT MRI in Enthesitis Initiative: Definitions of Key Pathologies, Suggested MRI Sequences and Novel Heel Enthesitis Scoring System (HEMRIS)

Objective: To develop and validate an enthesitis MRI-scoring system for spondyloarthritis/psoriatic arthritis, using the heel as model. Methods: Consensus definitions of key pathologies and three heel enthesitis multi-reader scoring exercises were done, separated by discussion, training and calibration. Results: Definitions for bone and soft tissue pathologies were agreed. In final exercise, median pairwise single-measures intra-class correlation coefficients(ICCs; patient-level) for entheseal inflammation status/change scores were 0.83/0.82 for all readers. For radiologists and selected rheumatologists ICCs were 0.91/0.84 and quadratic-weighted kappas(lesionlevel) 0.57-0.91/0.45-0.81. Conclusion: The proposed definitions and heel enthesitis scoring system (HEMRIS) are reliable among trained readers and promising for clinical trials

Current concepts and unmet needs in psoriatic arthritis

Psoriatic arthritis is a chronic inflammatory arthritis that is part of the spondyloarthropathy group of rheumatic diseases and has associated co-morbidities. It can present with various clinical manifestations making diagnosis and treatment challenging, resulting in significant disability and reduced quality of life for patients. Whilst there have been advances in understanding the pathogenic mechanisms of the disease which have resulted in targeted therapies, there is still the need for further studies as some patients fail or are intolerant of current therapies. Better identification of early disease and knowledge of prognostic markers would enable clinicians to initiate appropriate therapy with the expectation that early aggressive treatment will minimise joint damage progression. Improved knowledge of the condition would also enable clinicians to better tailor specific treatment strategies for each of the various clinical domains in psoriatic arthritis