PREVALENCE OF ULTRASOUND ABNORMALITIES IN PATIENTS WITH PSORIATIC ARTHRITIS IN A CLINICAL PHASE OF MINIMAL DISEASE ACTIVITY UNDER ANTI-TNF TREATMENT

Background: Few studies have analized the persistence of ultrasound (US) abnormalities in patients (pts) with Psoriatic Artritis (PA) during the phase of minimal disease activity (MDA) Objectives: To investigate the prevalence of US alterations at enthesis, joint and tendon levels in pts with psoriatic arthritis (PA) during a phase of MDA. Methods: Pts treated with anti-tumor necrosis factor (TNF) for at least 12 months and with at least 6 months duration of MDA were consecutively recruited at 6 Italian centers. In every center, the local rheumatologists provided PA pts to be examined by US. Personal history, demographic and clinical data were recorded. Each patient underwent the following US examinations: metacarpophalangeal (MCP), knee and tibio-tarsal (TT) joint, flexor and extensor tendon of hand digit, flexor and extensor tendon at carpal area, flexor and extensor tendon of foot, and enthesis of common extensor tendon insertion on the lateral epicondyle of the humerus, quadriceps tendon, patellar tendon, Achilles tendon and plantar fascia insertions on the calcaneus. Each examination were performed by rheumatologists expert in US, to assess synovitis (joint effusion, synovial proliferation, and power Doppler (PD) signal), and bone erosions, flexor tendon tenosynovitis, hand finger extensor tendon tenonitis, and enthesel involvement using an Esaote MyLabClass with a 5–13 or 6–18 MHz linear probe. The following elementary lesions were assessed at each enthesis: morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. All US findings were scored using a 4 degree semiquantitative scoring system. US acute enthesitis was defined by the presence of entheseal edema or PD signal. US chronic entheseal alterations by the presence of calcifications, erosions, or enthesophytes. US peripheral active synovitis if synovial hypertrophy was associated with the presence of PD signal. US examinator were blind of clinical data of the pts. Results: Sixty-three pts were recruited (mean age 53±13y, mean PA duration 13±8y, mean MDA duration 21±11m). At US examination 66.7% of pts had at least one peripheral joint involved (17.5% had peripheral active synovitis), 47.6% had acute enthesitis and 95.2% chronic enthesopathy. US bursitis was present in 22.2% of pts, 3.7% had hand extensor finger tendon involvement. Table 1 shows clinical and demographical data of the pts and table 2 the US results Nail involvement Previous dactylitis FamHyst IBP Patients with abnormality (%) 28.3 42.9 23.9 19.7 Table 2. US abnormalities in 63 pts in MDA Perypheral active sinovitis Joint peripheral involvement Chronic entheseal alterations Acute entheseal alterations Tenosynovitis Patients with abnormality (%) 17.5 66.7 95.2 47.6 29.6 Conclusions: Joint, entheseal and tendon abnormalities have a high prevalence in PA patients treated with anti-TNF during MDA.