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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BMJ Publishing Group
2025-08-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/11/3/e005785.full |
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| author | 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 |
| author_facet | 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 |
| author_sort | Ennio Lubrano |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-78ec3f0201974cc89eb89a5ca304665f |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-78ec3f0201974cc89eb89a5ca304665f2025-08-20T03:36:41ZengBMJ Publishing GroupRMD Open2056-59332025-08-0111310.1136/rmdopen-2025-005785Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritisEnnio Lubrano0Alen Zabotti1Ivan Giovannini2Luca Quartuccio3Fabio Massimo Perrotta4Andrea Di Matteo5Gabriele De Marco6Dennis McGonagle7Maria De Martino8Miriam Isola9Nicola Cabas10Cristina Di Nicola11Andrea Guiotto12Nicoletta Franzolini13Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute Vincenzo Tiberio, Università degli Studi del Molise, Campobasso, ItalyDepartment of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, ItalyDepartment of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, ItalyDepartment of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, ItalyAcademic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute Vincenzo Tiberio, Università degli Studi del Molise, Campobasso, ItalyNIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UKNIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UKNIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UKInstitute of Statistics, Department of Medicine (DMED), University of Udine, Udine, ItalyInstitute of Statistics, Department of Medicine (DMED), University of Udine, Udine, ItalyDepartment of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, ItalyEpidemiology Unit, Italian Society for Rheumatology (SIR), Milano, ItalyDepartment of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, ItalyPresidio Ospedaliero S. Antonio”, San Daniele del Friuli, ItalyObjective 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.https://rmdopen.bmj.com/content/11/3/e005785.full |
| spellingShingle | 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 Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis RMD Open |
| title | Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis |
| title_full | Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis |
| title_fullStr | Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis |
| title_full_unstemmed | Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis |
| title_short | Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis |
| title_sort | using ultrasound to define inflammatory and non inflammatory phenotypes in difficult to treat psoriatic arthritis |
| url | https://rmdopen.bmj.com/content/11/3/e005785.full |
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