Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis

Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis

Objective To investigate the prevalence of difficult-to-treat psoriatic arthritis (D2T-PsA) and classify patients with persistent inflammatory PsA (PIPsA) and non-inflammatory PsA (NIPsA) based on a combination of clinical and musculoskeletal ultrasound (MSUS) evidence of inflammation.Methods A mult...

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Main Authors: Ennio Lubrano, Alen Zabotti, Ivan Giovannini, Luca Quartuccio, Fabio Massimo Perrotta, Andrea Di Matteo, Gabriele De Marco, Dennis McGonagle, Maria De Martino, Miriam Isola, Nicola Cabas, Cristina Di Nicola, Andrea Guiotto, Nicoletta Franzolini
Format: Article
Language:English
Published: BMJ Publishing Group 2025-08-01
Series:RMD Open
Online Access:https://rmdopen.bmj.com/content/11/3/e005785.full
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Summary:Objective To investigate the prevalence of difficult-to-treat psoriatic arthritis (D2T-PsA) and classify patients with persistent inflammatory PsA (PIPsA) and non-inflammatory PsA (NIPsA) based on a combination of clinical and musculoskeletal ultrasound (MSUS) evidence of inflammation.Methods A multicentre cross-sectional study was conducted on PsA patients treated with biological disease-modifying anti-rheumatic drugs/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). D2T-PsA status was characterised by an inadequate response to ≥2 classes of b/tsDMARDs and the persistence of active disease, defined as a DAPSA >14.Results Out of 517 PsA patients on b/tsDMARDs, 53 (10.3%) met the criteria for D2T-PsA with 30 (57%) classified as PIPsA and 23 (43%) classified as NIPsA. The PIPsA phenotype had higher swollen joint count (2.5 (IQR 1.0–7.0) vs 0.0 (IQR 0.0–1.0), p<0.001), dactylitis (20% vs 0%, p=0.030) and nail psoriasis (40% vs 13%, p=0.027). Conversely, NIPsA patients had significantly greater ΔPtGA–PhGA (4.0 (IQR 2.5–5.0) vs 0.0 (IQR 0.0–1.5), p<0.001), higher tender points (16.0 (IQR 0.0–18.0) vs 0.0 (IQR 0.0–8.0), p=0.009), a higher SPARCC enthesitis index (5.0 (IQR 2.0–8.0) vs 2.0 (IQR 0.0–5.0), p=0.023). The MSUS showed higher ultrasound activity (3.81±2.0 vs 0.91±0.5, p<0.001) and greater structural damage (4.12±1.0 vs 2.38±2.1, p<0.001), with both activity and damage scores being higher in PIPsA patients.Conclusion The classification into PIPsA and NIPsA based on easily detectable clinical features can support a tailored therapeutic management of patients with D2T-PsA.
ISSN:2056-5933

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