Sonographic Enthesitis as a Potential Marker of Radiographic Damage Severity in PsA

Enthesitis is reported to occur in approximately one-third of patients with psoriatic arthritis (PsA).¹ The association between sonographic enthesitis and severity of radiographic features of peripheral and axial joint damage in patients with PsA was recently investigated in a cross-sectional analysis published in Arthritis Research & Therapy.²  Severity of both proliferative and erosive bone lesions was predicted by severity of sonographic enthesitis, suggesting that sonographic enthesitis may be a marker for PsA radiographic joint damage. 

The MAdrid Sonography Enthesitis Index (MASEI) scoring system was used to quantify the severity of patients’ sonographic abnormalities. The association between MASEI score and the various radiographic features of joint damage was assessed via the use of negative binomial and logistic regression. Radiographic damage in the peripheral joints and spine was evaluated by the modified Steinbrocker score (mSS), modified New York criteria for sacroiliitis, and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS).

A total of 223 patients with PsA (58% men; mean age, 56 years; mean PsA duration, 16.9 years) were enrolled in the study.

Regression analyses demonstrated an association between higher MASEI scores (10-unit increase) and peripheral joint damage, including mSS (exponentiated value [e^β], 1.42; 95% CI, 1.15-1.72), joint ankyloses (odds ratio [OR], 1.93; 95% CI, 1.37-2.72), arthritis mutilans (OR, 1.77; 95% CI, 1.23-2.54), and periostitis (OR, 1.41; 95% CI, 1.08-1.84).

An association was also reported between higher MASEI scores and axial damage, as calculated by mSASSS (e^β, 2.18; 95% CI, 1.16-4.09) and sacroiliitis (OR, 1.33; 95% CI, 1.03-1.72).

The investigators concluded that the severity of sonographic enthesitis is a potential marker of radiographic peripheral and axial joint damage in patients with RA.

Additional longitudinal studies in patients with early PsA are warranted in order to establish the exact relationship among enthesitis, synovitis, and joint damage.

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References

1. Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis inpatients with severe psoriasis with suboptimal performance of screeningquestionnaires. Ann Rheum Dis. 2013;72(5):736-740.
2. Polachek A, Cook R, Chandran V, Gladman DD, Eder L. The association between sonographic enthesitis and radiographic damage in psoriatic arthritis. Arthritis Res Ther. 2017;19(1):189.