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Caso F, Costa L, Megna M, Cascone M, Maione F, Giacomelli R, Scarpa R, Ruscitti P. Early psoriatic arthritis: clinical and therapeutic challenges. Expert Opin Investig Drugs 2024:1-21. [PMID: 39041193 DOI: 10.1080/13543784.2024.2383421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease of the enthesis and adjacent synovium, skin, and nail, which early diagnosis may be crucial for starting a prompt therapeutic intervention. Theoretically, early treatment offers the advantage of acting on the reduction of the articular damage progression since initial phases of the disease. AREAS COVERED This review explores the challenges of clinical-diagnostic aspects and the underlying pathophysiology of early PsA phases, as well as the evidence evaluating the impact of early intervention on disease outcomes. EXPERT OPINION Main instruments for early PsA diagnosis include recognizing synovial-entheseal inflammatory signs at onset, improving screening PsA high-risk subjects, and increasing disease knowledge of physicians and patients with psoriasis or familial history. PsA continues to significantly impact on the Quality of Life of patients affected by the disease, making necessary to deeply study clinical manifestations, risk factors, and underlying immunoinflammatory mechanisms, as well as to identify biomarkers for early identification. Additionally, it remains a need to increase more evidence on understanding how early treatment of PsA and of psoriasis might influence the course of the disease.
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Affiliation(s)
- Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luisa Costa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mario Cascone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Maione
- ImmunoPharmaLab, Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto Giacomelli
- Research and Clinical Unit of immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Rheumatology, Immunology and Clinical Medicine Unit, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Naredo E, D'Agostino MA, Terslev L, Pineda C, Miguel MI, Blasi J, Bruyn GA, Kortekaas MC, Mandl P, Nestorova R, Szkudlarek M, Todorov P, Vlad V, Wong P, Bakewell C, Filippucci E, Zabotti A, Micu M, Vreju F, Mortada M, Mendonça JA, Guillen-Astete CA, Olivas-Vergara O, Iagnocco A, Hanova P, Tinazzi I, Balint PV, Aydin SZ, Kane D, Keen H, Kaeley GS, Möller I. Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis. Ann Rheum Dis 2024; 83:1060-1071. [PMID: 38531611 DOI: 10.1136/ard-2023-225278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - M Isabel Miguel
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - Joan Blasi
- Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - George A Bruyn
- Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands
- Reumakliniek Flevoland, Lelystad, Netherlands
| | - Marion C Kortekaas
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands
| | - Peter Mandl
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria
| | | | - Marcin Szkudlarek
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Zealand's University Hospital, Køge, Denmark
| | - Plamen Todorov
- Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Violeta Vlad
- Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania
| | - Priscilla Wong
- Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania
| | - Florentin Vreju
- Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Mohamed Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - José Alexandre Mendonça
- Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil
| | | | - Otto Olivas-Vergara
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
- Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary
| | - Sibel Zehra Aydin
- Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Helen Keen
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ingrid Möller
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
- Instituto Poal de Reumatología, Barcelona, Spain
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Wu A, Scher JU, Ogdie A, Ritchlin C, Merola JF. Prevention of Psoriatic Arthritis: The Need for Prospective Studies. Dermatol Clin 2024; 42:429-438. [PMID: 38796274 DOI: 10.1016/j.det.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Psoriatic arthritis (PsA) is a systemic chronic inflammatory disease that develops in up to 30% of patients with psoriasis. Mixed data variably support the potential ability to "prevent" and/or delay PsA through use of systemic therapies in psoriasis patients. Though intriguing, almost all of these studies are retrospective in nature, and hold substantial limitations and potential biases that challenge the ability to meaningfully interpretation their results. Thus, the authors believe prospective observational and interventional studies are crucial to understanding our ability to truly modify the transition from psoriasis to psoriatic arthritis and delay or prevent PsA onset.
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Affiliation(s)
- Alexander Wu
- Department of Dermatology, UT Southwestern Medical Center, 5939 Harry Hines Boulevard 4th Floor, Suite 100, Dallas, TX 75390, USA; University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jose U Scher
- Department of Medicine at NYU Grossman School of Medicine, 333 East 38th Street, 4th Floor, New York, NY 10016, USA
| | - Alexis Ogdie
- Department of Medicine (Rheumatology) and Epidemiology, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Christopher Ritchlin
- Department of Medicine, University of Rochester Medical Center, 400 Red Creek Drive, Suite 200, Rochester, NY 14623, USA
| | - Joseph F Merola
- Department of Dermatology, UT Southwestern Medical Center, 5939 Harry Hines Boulevard 4th Floor, Suite 100, Dallas, TX 75390, USA; Division of Rheumatology, Department of Internal Medicine, University of Texas Southwestern Medical Center; UT Southwestern Medical School and O'Donnell School of Public Health, 5939 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Ricci V, Tamborrini G, Zunica F, Chang KV, Kara M, Farì G, Naňka O, Özçakar L. High-resolution ultrasound imaging of elementary lesions in dactylitis. J Ultrasound 2024; 27:281-290. [PMID: 38006512 PMCID: PMC11178685 DOI: 10.1007/s40477-023-00834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/02/2023] [Indexed: 11/27/2023] Open
Abstract
OBJECTIVE The aim of the present study was to illustrate the (potential) diagnostic role of high resolution US images in assessing the elementary lesions of dactylitis. METHODS Using high-frequency US machines/probes, we matched the micro-anatomical cadaveric architecture of the digit with multiple sonographic findings of dactylitis. High-sensitive color/power Doppler assessments have also been performed to evaluate the digital microvasculature. DISCUSSION Modern US equipment/features guarantee prompt and in-depth B-mode and color/power Doppler imaging of tiny anatomical structures of the digit which are usually not properly visible with standard US machines. More specifically, hypervascularization of the digital subcutaneous tissue, fibrous pulleys of flexor tendons, dorsal synovial pads as well as pathological changes of the distal entheseal anchorage network can be accurately detected. CONCLUSION In clinical practice, high-end US equipment can be used to accurately assess the digits in patients with dactylitis. This way, simple and convenient sonographic diagnosis of different elementary lesions can be timely established.
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Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Giorgio Tamborrini
- UZR, Ultraschallzentrum und Institut für Rheumatologie, Basel, Switzerland
- Rheumatology Clinic, University Hospital of Basel, Basel, Switzerland
| | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, 20154, Milan, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Huy Branch, Taipei, Taiwan
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine Ankara, Hacettepe University Medical School, Ankara, Turkey
| | - Giacomo Farì
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, Lecce, Italy
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine Ankara, Hacettepe University Medical School, Ankara, Turkey
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Bonfiglioli KR, Lopes FODA, de Figueiredo LQ, Ferrari LFF, Guedes L. Ultrasonographic Insights into Peripheral Psoriatic Arthritis: Updates in Diagnosis and Monitoring. J Pers Med 2024; 14:550. [PMID: 38929771 PMCID: PMC11205202 DOI: 10.3390/jpm14060550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Reumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil; (F.O.d.A.L.); (L.Q.d.F.); (L.F.F.F.); (L.G.)
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Skougaard M, Søndergaard MF, Ditlev SB, Kristensen LE. Changes in Inflammatory Cytokines in Responders and Non-Responders to TNFα Inhibitor and IL-17A Inhibitor: A Study Examining Psoriatic Arthritis Patients. Int J Mol Sci 2024; 25:3002. [PMID: 38474247 PMCID: PMC10932211 DOI: 10.3390/ijms25053002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
This study aimed to examine the changes in biomarker levels in responders and non-responders to tumor necrosis factor alpha inhibitor (TNFi) and interleukin-17A inhibitor (IL-17Ai) in psoriatic arthritis (PsA) patients over a 4-month period after treatment initiation. A total of 68 PsA patients initiating either TNFi, IL-17Ai, or methotrexate treatment were included. Blood plasma and clinical outcome measures were collected adjacent to treatment initiation and after four months. A commercially available multiplex immunoassay was included to evaluate 54 biomarkers. Mean changes were used to evaluate change over time. A statistically significant decrease in pro-inflammatory cytokines IL-6 (log-transformed mean change -0.97, 95%CI -4.30; 2.37, [p = 0.032]) and an increase in anti-inflammatory IL-10 (0.38, 95%CI 1.74; 2.50 [p = 0.010]) were seen in TNFi responders. Meanwhile, a statistically significant increase in the target cytokine IL-17A was seen in both IL-17Ai responders (2.49, 95%CI -1.84; 6.85 [p = 0.031]) and non-responders (2.48, 95%CI -1.46; 6.41 [p = 0.001]). This study demonstrated differing changes in cytokine levels when comparing treatment responders and non-responders, highlighting the need to improve the understanding of the different immune response mechanisms explaining different responses to medical treatment in PsA patients.
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Affiliation(s)
- Marie Skougaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Magnus Friis Søndergaard
- Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Sisse Bolm Ditlev
- Copenhagen Center for Translational Research, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Gitto S, Albano D, Serpi F, Spadafora P, Colombo R, Messina C, Aliprandi A, Sconfienza LM. Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:54-60. [PMID: 37001562 DOI: 10.1055/a-2066-9230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the role of ultrasound (US) in the evaluation of intrinsic and extrinsic ligaments of the wrist with magnetic resonance arthrography (MRA) as the reference standard. MATERIALS AND METHODS This prospective study included patients referred for MRA after wrist trauma. US examination was performed just before MRA. On the dorsal and palmar sides of the wrist, the intrinsic interosseus and midcarpal, extrinsic, and collateral ligaments were evaluated. MRA was performed on a 1.5-T unit. In the first 20 patients included, ligament thickness was independently assessed using US and MRA and thickness reproducibility was calculated. Ligament integrity was evaluated in all patients. RESULTS 38 patients (22 men, 16 women; mean age: 38 years) were included. Ligament thickness reproducibility ranged between 44% for the palmar ulnocapitate ligament and 71% for the palmar scaphotriquetral ligament. US had a sensitivity, specificity, positive and negative predictive values, and accuracy of 100% in the identification of tears of the palmar (n=8) and dorsal (n=3) bands of the scapholunate ligament and the ulnar collateral ligament (n=3). It had a sensitivity of 100%, specificity of 97%, positive predictive value of 50%, negative predictive value of 100%, and accuracy of 97% in the identification of tears of the palmar ulnolunate ligament (n=1). CONCLUSION Compared to MRA, US showed good reproducibility in the assessment of wrist ligament thickness and similar accuracy with respect to identifying tears of the scapholunate, palmar ulnolunate, and ulnar collateral ligaments.
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Affiliation(s)
- Salvatore Gitto
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Domenico Albano
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Pierino Spadafora
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Roberta Colombo
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Carmelo Messina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | | | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Diagnostic and Interventional Radiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Venerito V, Del Vescovo S, Lopalco G, Proft F. Beyond the horizon: Innovations and future directions in axial-spondyloarthritis. Arch Rheumatol 2023; 38:491-511. [PMID: 38125058 PMCID: PMC10728740 DOI: 10.46497/archrheumatol.2023.10580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the spine and sacroiliac joints. This review discusses recent advances across multiple scientific fields that promise to transform axSpA management. Traditionally, axSpA was considered an immune-mediated disease driven by human leukocyte antigen B27 (HLA-B27), interleukin (IL)-23/IL-17 signaling, biomechanics, and dysbiosis. Diagnosis relies on clinical features, laboratory tests, and imaging, particularly magnetic resonance imaging (MRI) nowadays. Management includes exercise, lifestyle changes, non-steroidal anti-inflammatory drugs and if this is not sufficient to achieve disease control also biological and targeted-synthetic disease modifying anti-rheumatic drugs. Beyond long-recognized genetic risks like HLA-B27, high-throughput sequencing has revealed intricate gene-environment interactions influencing dysbiosis, immune dysfunction, and aberrant bone remodeling. Elucidating these mechanisms promises screening approaches to enable early intervention. Advanced imaging is revolutionizing the assessment of axSpA's hallmark: sacroiliac bone-marrow edema indicating inflammation. Novel magnetic resonance imaging (MRI) techniques sensitively quantify disease activity, while machine learning automates complex analysis to improve diagnostic accuracy and monitoring. Hybrid imaging like synthetic MRI/computed tomography (CT) visualizes structural damage with new clarity. Meanwhile, microbiome analysis has uncovered gut ecosystem alterations that may initiate joint inflammation through HLA-B27 misfolding or immune subversion. Correcting dysbiosis represents an enticing treatment target. Moving forward, emerging techniques must augment patient care. Incorporating patient perspectives will be key to ensure innovations like genetics, microbiome, and imaging biomarkers translate into improved mobility, reduced pain, and increased quality of life. By integrating cutting-edge, multidisciplinary science with patients' lived experience, researchers can unlock the full potential of new technologies to deliver transformative outcomes. The future is bright for precision diagnosis, tightly controlled treatment, and even prevention of axSpA.
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Affiliation(s)
- Vincenzo Venerito
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Sergio Del Vescovo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Fagni F, Mutlu MY, Temiz SA, Minopoulou I, Krieter M, Schett G, Kleyer A, Simon D, Hueber AJ. Tolerability of low to moderate biomechanical stress during leisure sport activity in patients with psoriasis and psoriatic arthritis. RMD Open 2023; 9:e003612. [PMID: 38053458 DOI: 10.1136/rmdopen-2023-003612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES To assess the impact of low to moderate biomechanical stress on entheses in patients with psoriasis and psoriatic arthritis (PsA). METHODS We conducted a prospective interventional study on a cohort of psoriasis and PsA patients who underwent a 60 min badminton training session. Pain assessment by Visual Analogue Scale (VAS), physical examination of 29 entheses (SPARCC, LEI, MASES) and bilateral ultrasound at the lateral humeral epicondyle, inferior patellar pole and Achilles tendon were performed before and after training. Ultrasound changes were assessed using the OMERACT scoring system. A follow-up assessment of pain and adverse events was performed at 1 week. RESULTS Sixteen patients were included (n=7 PsA; n=9 psoriasis) and 196 entheseal ultrasound scans were acquired. At baseline, median VAS pain (IQR) was 0.5 cm (0-2.3) and the total number of tender entheses was 12/464. Mean (min; max) Disease Activity Index for Psoriatic Arthritis was 6.1 (0.8; 19) and 5/7 PsA patients had an Minimal Disease Activity status. After training, no significant change in VAS pain (0.0 cm (0.0-2.0)) nor in tender entheses (13/464) emerged. Four patients (n=2 PsA, n=2 psoriasis) developed a grade-1 power Doppler-signal at six entheses, which, however, remained non-tender. At 1 week, median VAS pain remained stable (0.0 cm (0.0-3.0); p>0.05) and only one participant with active PsA at baseline reported increased arthralgias in three joints. CONCLUSIONS Low to moderate physical strain, as in the context of leisure sport activity, seems well tolerated in psoriatic patients without increases in tenderness, pain and ultrasound-proven inflammation. Evidence-based recommendations for physical activity in PsA are direly needed and larger controlled studies should be conducted to define safe exercise thresholds.
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Affiliation(s)
- Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Melek Yalcin Mutlu
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Selahattin Alp Temiz
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
| | - Manuel Krieter
- Department of Dermatology, Paracelsus Medical University, Nürnberg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum, Erlangen, Germany
- Klinikum Nürnberg, Division of Rheumatology, Paracelsus Medical University, Nürnberg, Germany
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10
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Adamson SR, Lam S, Veysey E. A case of dactylitis post-cryotherapy for management of common warts. Australas J Dermatol 2023; 64:e288-e289. [PMID: 37435948 DOI: 10.1111/ajd.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Sarah R Adamson
- Vulvar Disorders and Dermatology Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
- Victorian Melanoma Service, The Alfred, Melbourne, Victoria, Australia
| | - Simon Lam
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - Emma Veysey
- Vulvar Disorders and Dermatology Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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11
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Mauro D, Gandolfo S, Tirri E, Schett G, Maksymowych WP, Ciccia F. The bone marrow side of axial spondyloarthritis. Nat Rev Rheumatol 2023:10.1038/s41584-023-00986-6. [PMID: 37407716 DOI: 10.1038/s41584-023-00986-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/07/2023]
Abstract
Spondyloarthritis (SpA) is characterized by the infiltration of innate and adaptive immune cells into entheses and bone marrow. Molecular, cellular and imaging evidence demonstrates the presence of bone marrow inflammation, a hallmark of SpA. In the spine and the peripheral joints, bone marrow is critically involved in the pathogenesis of SpA. Evidence suggests that bone marrow inflammation is associated with enthesitis and that there are roles for mechano-inflammation and intestinal inflammation in bone marrow involvement in SpA. Specific cell types (including mesenchymal stem cells, innate lymphoid cells and γδ T cells) and mediators (Toll-like receptors and cytokines such as TNF, IL-17A, IL-22, IL-23, GM-CSF and TGFβ) are involved in these processes. Using this evidence to demonstrate a bone marrow rather than an entheseal origin for SpA could change our understanding of the disease pathogenesis and the relevant therapeutic approach.
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Affiliation(s)
- Daniele Mauro
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Saviana Gandolfo
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Enrico Tirri
- Unit of Rheumatology, San Giovanni Bosco Hospital, Naples, Italy
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University (FAU) Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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12
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Phenotypic heterogeneity in psoriatic arthritis: towards tissue pathology-based therapy. Nat Rev Rheumatol 2023; 19:153-165. [PMID: 36596924 DOI: 10.1038/s41584-022-00874-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 01/04/2023]
Abstract
Psoriatic arthritis (PsA) is a heterogeneous disease involving multiple potential tissue domains. Most outcome measures used so far in randomized clinical trials do not sufficiently reflect this domain heterogeneity. The concept that pathogenetic mechanisms might vary across tissues within a single disease, underpinning such phenotype diversity, could explain tissue-distinct levels of response to different therapies. In this Review, we discuss the tissue, cellular and molecular mechanisms that drive clinical heterogeneity in PsA phenotypes, and detail existing tissue-based research, including data generated using sophisticated interrogative technologies with single-cell precision. Finally, we discuss how these elements support the need for tissue-based therapy in PsA in the context of existing and new therapeutic modes of action, and the implications for future PsA trial outcomes and design.
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13
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Izci Duran T, Torgutalp M, Rios Rodriguez V, Proft F, López-Medina C, Dougados M, Poddubnyy D. The impact of psoriasis on the clinical characteristics, disease burden and treatment patterns of peripheral spondyloarthritis. Rheumatology (Oxford) 2022; 62:135-146. [PMID: 35451472 DOI: 10.1093/rheumatology/keac235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, disease burden, and treatment patterns of peripheral spondyloarthritis (pSpA) patients with and without psoriasis using data from the ASAS-perSpA study. METHODS We included 433 patients who had a diagnosis of pSpA according to the rheumatologist's diagnosis from the ASAS-PerSpA study. The presence of a personal history of psoriasis was defined as the presence of signs of psoriasis at physical examination or the presence of psoriatic nail dystrophy, including onycholysis, pitting and hyperkeratosis, or a history of psoriasis diagnosed by a physician. Clinical characteristics, patient-reported outcomes and treatment pattern were compared between subgroups with and without psoriasis. RESULTS A total of 83 patients (19.2%) had a personal history of psoriasis. Patients with psoriasis were older (48.4 vs 43.2 years) and had a longer diagnostic delay (7.4 vs 3.5 years), a higher frequency of dactylitis (36.1 vs 20.0%) and enthesitis (65.1 vs 55.4%) than patients without psoriasis. A longer diagnostic delay (odds ratio [OR] = 1.06 [95% CI 1.01, 1.11]), lower odds for HLA-B27 positivity (OR = 0.31 [95% CI 0.15, 0.65]) and higher odds for enthesitis (OR = 2.39 [95% CI 1.16, 4.93]) were associated with the presence of psoriasis in a multivariable regression analysis. While patient-reported outcomes were comparable between groups, a higher use of biologic DMARDs was observed in patients with vs without psoriasis. CONCLUSION The presence of psoriasis has an impact on clinical characteristics of pSpA. pSpA patients without psoriasis were less frequently treated with biologic DMARDs despite similar disease burden as compared with patients with psoriasis.
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Affiliation(s)
- Tugba Izci Duran
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Clementina López-Medina
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,Department of Rheumatology, Reina Sofia Hospital, IMIBIC, University of Cordoba, Cordoba, Spain
| | - Maxime Dougados
- Department of Rheumatology, Université de Paris, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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14
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Bilgin E. Autoinflammation in psoriatic arthritis: time to better define the multifaceted enemy. RMD Open 2022; 8:rmdopen-2022-002685. [PMID: 36323489 PMCID: PMC9639151 DOI: 10.1136/rmdopen-2022-002685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Emre Bilgin
- Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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15
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Abstract
Spondyloarthropathies, also known as spondyloarthritis, encompasses a spectrum of diseases classified by it's axial and peripheral musculoskeletal manifestations. Extra-articular features are common in SpA making these systemic rheumatologic diseases involve the skin, eye, gut, and other organ systems.Research has identified risk factors for the development of spondyloarthritis, particularly regarding genetic susceptibility and the strong association with HLA-B27. Multiple studies have elucidated clinical risk factors associated with SpA disease activity and severity. In this review, we aim to explore the environmental risk factors for spondyloarthritis.
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Affiliation(s)
- Yvette Farran
- Division of Rheumatology, Department of Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at The University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX 77030, USA
| | - John Reveille
- Division of Rheumatology, Department of Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at The University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX 77030, USA
| | - Mark Hwang
- Division of Rheumatology, Department of Internal Medicine, John P. and Kathrine G. McGovern School of Medicine at The University of Texas Health Science Center at Houston, 6431 Fannin MSB 5.270, Houston, TX 77030, USA.
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16
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Koreshkova KM, Khismatullina ZR. The role of trauma and isomorphic reaction in the pathogenesis of psoriatic arthritis. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The role of biomechanical stress and trauma in the initiation of inflammation of the joints and periarticular structures in psoriatic arthritis (PA) is currently not fully understood. Soft tissues and joints are the target for constant biomechanical stress and microtrauma, leading to inflammation. There is an opinion that this inflammation in PA is due to an analogue of the skin isomorphic reaction that develops in the skin of psoriatic patients in response to trauma. Some authors have called this reaction the deep Koebner phenomenon. It is assumed that the early, preclinical phase of psoriatic arthritis may be based on inflammation of the enthesis as a response to microtrauma, and explained by the proximity of the entheses and the articular membranes. Detection of early changes in entheses in psoriatic patients, including those who do not have complaints from the musculoskeletal system, is of great importance for the early diagnosis of psoriatic arthritis. In the literature review, the sources for the period 20102021 were studied, devoted to the role of the isomorphic reaction and microtraumatization in the pathogenesis of PA, as well as the role of various imaging methods for the early diagnosis of enthesitis in psoriatic patients.
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17
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Molecular and cellular regulation of psoriatic inflammation. Clin Sci (Lond) 2022; 136:935-952. [PMID: 35730381 DOI: 10.1042/cs20210916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2023]
Abstract
This review highlights the molecular and cellular mechanisms underlying psoriatic inflammation with an emphasis on recent developments which may impact on treatment approaches for this chronic disease. We consider both the skin and the musculoskeletal compartment and how different manifestations of psoriatic inflammation are linked. This review brings a focus to the importance of inflammatory feedback loops that exist in the initiation and chronic stages of the condition, and how close interaction between the epidermis and both innate and adaptive immune compartments drives psoriatic inflammation. Furthermore, we highlight work done on biomarkers to predict the outcome of therapy as well as the transition from psoriasis to psoriatic arthritis.
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18
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Li B, Li G, Yang X, Song Z, Wang Y, Zhang Z. NETosis in Psoriatic Arthritis: Serum MPO–DNA Complex Level Correlates With Its Disease Activity. Front Immunol 2022; 13:911347. [PMID: 35774788 PMCID: PMC9238436 DOI: 10.3389/fimmu.2022.911347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNeutrophil extracellular trap formation (NETosis) has been rarely reported in psoriatic arthritis (PsA). We aimed to explore the involvement of NETosis in the inflammation of PsA.MethodsSerum myeloperoxidase–DNA (MPO-DNA) complex was detected by a modified enzyme-linked immunosorbent assay and compared among 74 patients with PsA, 58 patients with psoriasis (PsO), and 20 healthy controls. The association of MPO–DNA level with disease activity index at baseline and follow-up was analyzed in patients with PsA. Receiver operating characteristic curve was used to evaluate the predictive value of MPO–DNA for treatment response.ResultsMPO–DNA complex level in serum was significantly increased in patients with PsA/PsO compared to healthy controls (p < 0.001). The level of MPO–DNA was positively associated with DAPSA score and its components (including TJC, SJC, PGA, VAS-pain and CRP, r = 0.25–0.409, all p-values < 0.05). Serum MPO–DNA level was downregualted at 12 weeks after treatment compared to baseline (p = 0.022). The decrease of MPO–DNA level was more dramatic in patients with PsA who achieved both ACR50 and PASI50 response than those achieving neither of them at 12 weeks (p = 0.023). ROC analysis revealed that the serum MPO–DNA level predicted both ACR50 and PASI50 achievement at week 12 (p = 0.04; 95% CIs, 0.56–0.94). Moreover, the baseline MPO–DNA level (p = 0.009; 95% CIs, 0.748–1) and change of MPO–DNA at week 12 from baseline (p = 0.004; 95% CIs, 0.802–1) were associated with the achievement of both ACR70 and PASI75 response at week 24.ConclusionsNETosis plays an important role in psoriatic diseases. The level of MPO–DNA complex in serum reflects disease activity. Serum MPO–DNA complex may be a useful biomarker to predict the therapeutic response in PsA.
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19
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Coates LC, de Wit M, Buchanan-Hughes A, Smulders M, Sheahan A, Ogdie AR. Residual Disease Associated with Suboptimal Treatment Response in Patients with Psoriatic Arthritis: A Systematic Review of Real-World Evidence. Rheumatol Ther 2022; 9:803-821. [PMID: 35412298 PMCID: PMC9127027 DOI: 10.1007/s40744-022-00443-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/14/2022] [Indexed: 01/18/2023] Open
Abstract
Objective This systematic literature review aimed to identify and summarise real-world observational studies reporting the type, prevalence and/or severity of residual symptoms and disease in adults with psoriatic arthritis (PsA) who have received treatment and been assessed against remission or low disease activity targets. Methods Patients had received treatment and been assessed with treat-to-target metrics, including minimal disease activity (MDA), Disease Activity Index in PsA (DAPSA) and others. MEDLINE, Embase® and the Cochrane Database of Systematic Reviews (CDSR) were searched using search terms for PsA, treatment targets and observational studies. Screening of search results was completed by two independent reviewers; studies were included if they reported relevant residual disease outcomes in adults with PsA who had received one or more pharmacological treatments for PsA in a real-world setting. Non-observational studies were excluded. Information from included studies was extracted into a prespecified grid by a single reviewer and checked by a second reviewer. Results Database searching yielded 2328 articles, of which 42 publications (27 unique studies) were included in this systematic literature review. Twenty-three studies reported outcomes for MDA-assessed patients, and 14 studies reported outcomes for DAPSA-assessed patients. Physician- and patient-reported residual disease was less frequent and/or severe in patients reaching targets, but often not absent, including when patients achieved very low disease activity (VLDA) or remission. For example, studies reported that 0–8% patients in remission according to DAPSA (or clinical DAPSA) had > 1 tender joint, 25–39% had Psoriasis Area and Severity Index (PASI) score > 1 and 0–10% had patient-reported pain > 15. Residual disease was usually less frequent and/or severe among patients achieving MDA-assessed targets versus DAPSA-assessed targets, especially for skin outcomes. Conclusion The findings demonstrate a need for further optimisation of care for patients with PsA.
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Affiliation(s)
- Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Maartje Smulders
- UCB Pharma, Anderlecht, Belgium
- Present Address: Astellas Pharma Europe B.V., Leiden, The Netherlands
| | | | - Alexis R. Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
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20
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Mease PJ, Bhutani MK, Hass S, Yi E, Hur P, Kim N. Comparison of Clinical Manifestations in Rheumatoid Arthritis vs. Spondyloarthritis: A Systematic Literature Review. Rheumatol Ther 2022; 9:331-378. [PMID: 34962619 PMCID: PMC8964901 DOI: 10.1007/s40744-021-00407-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Misclassification of spondyloarthritis (SpA) as rheumatoid arthritis (RA) may lead to delayed SpA diagnosis and suboptimal therapeutic outcomes. Here, we evaluate the literature on clinical manifestations in patients with SpA and RA, particularly seronegative RA, to understand the potential overlap, distinctions, and most reliable approaches to accurate diagnosis. METHODS In this systematic literature review, conducted according to PRISMA guidelines, we searched key biomedical databases for English-language publications of original research articles (up to July 23, 2020) and rheumatology conference abstracts (January 1, 2018-July 31, 2020) reporting key SpA clinical presentations in patients with SpA or RA. Publications were assessed for eligibility by two independent reviewers; discrepancies were resolved by a third. Studies were evaluated for publication quality using the Downs and Black checklist. RESULTS Of 4712 records retrieved, 79 met the inclusion criteria and were included in the analysis. Of these, 54 included study populations with SpA and RA, and 25 with seropositive and/or seronegative RA. Entheseal abnormalities were more frequently reported among patients with SpA than RA and with seronegative vs. seropositive RA. Psoriasis, nail psoriasis, and dactylitis were exclusively seen in SpA vs. RA. In most publications (70 of 79), advanced imaging techniques allowed for more accurate distinction between SpA and RA. Overlapping clinical characteristics occur in SpA and RA, including inflammation and destruction of joints, pain, diminished functional ability, and increased risk for comorbidities. However, of 54 studies comparing SpA and RA populations, only seven concluded that no distinction can be made based on the SpA manifestations and outcomes examined. CONCLUSIONS Typical SpA-related clinical symptoms and signs were observed in patients with RA, suggesting that misclassification could occur. Availability of advanced imaging modalities may allow for more prompt and comprehensive evaluation of peripheral manifestations in SpA and RA, reducing misclassification and delayed diagnosis.
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Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA.
- Seattle Rheumatology Associates, 601 Broadway, Suite 600, Seattle, WA, 98122, USA.
| | | | | | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Peter Hur
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Nina Kim
- Baylor Scott & White Health, Temple, TX, USA
- University of Texas at Austin, Austin, TX, USA
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21
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Sarbu MI, Sarbu N, Cristea Ene D, Corche D, Baz R, Negru D, Nechita A, Fotea S, Anghel L, Tatu AL. New Perspectives on Diagnosing Psoriatic Arthritis by Imaging Techniques. Open Access Rheumatol 2021; 13:343-352. [PMID: 35221735 PMCID: PMC8866993 DOI: 10.2147/oarrr.s331859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Psoriatic arthritis is a chronic inflammatory condition that can lead to severe functional impairment and irreversible damage. The diagnosis can be difficult in early cases where the clinical exam is often scarce. The lack of a serological biomarker can lead to a considerable delay in diagnosis. In this review, we discuss the existent imaging methods that have improved the diagnosis of psoriatic arthritis (PsA). The degree and type of musculoskeletal involvement cannot be assessed by only one imaging method. We think that a combination of methods is the best approach to evaluate both structural damage and inflammatory lesions and that ultrasound (US) could be the best tool to screen a patient when considering the diagnosis of PsA. US is an accessible, non-ionizing technique that offers information regarding active inflammation in joints, entheses, and soft tissues.
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Affiliation(s)
| | - Nicolae Sarbu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Al. I. Cuza No 35, Galati, Romania
- Correspondence: Nicolae Sarbu Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Al. I. Cuza No 35, Galati, RomaniaTel +40728301044 Email
| | | | - Daniela Corche
- Sf Apostol Andrei Clinical County Emergency Hospital, Galati, Romania
| | - Radu Baz
- Department of Radiology and Medical Imaging, Clinical County Emergency Hospital Constanta, “Ovidius” University, Constanta, Romania
| | - Dragos Negru
- Department of Radiology – Imaging, University Hospital “Sf. Spiridon”, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania
- Department of Pediatrics, “Sf. Ioan” Clinical Hospital for Children, Galati, Romania
| | - Silvia Fotea
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania
- Department of Pediatrics, “Sf. Ioan” Clinical Hospital for Children, Galati, Romania
| | - Lucretia Anghel
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania
- Sf Apostol Andrei Clinical County Emergency Hospital, Galati, Romania
| | - Alin Laurentiu Tatu
- Faculty of Medicine and Pharmacy, Clinical Department, Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform’, ReForm-UDJG, “Dunarea de Jos” University, Galati, Romania
- Clinical Hospital St Parascheva of Infectious Diseases, Dermatology Department, Galati, Romania
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22
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Terlemez R, Palamar D, Misirlioglu TO, Akgun K. Psoriatic dactylitis: Koebner phenomenon of the pulleys-comment on "Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA?". Quant Imaging Med Surg 2021; 11:4687-4689. [PMID: 34737936 DOI: 10.21037/qims-21-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Rana Terlemez
- Department of Physical Medicine and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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23
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Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic Arthritis, the Sonographic Perspective. Curr Rheumatol Rep 2021; 23:75. [PMID: 34427783 PMCID: PMC8384799 DOI: 10.1007/s11926-021-01039-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To provide an overview of the ultrasound (US) studies focusing on enthesitis in psoriatic arthritis (PsA). Recent Findings Last-generation US equipment has demonstrated the ability to detect subtle morphostructural and vascular abnormalities at entheseal level. US is able to identify pathologic changes in both “classical” (i.e., the site of attachment of tendons, ligaments, and joint capsules into the bone) and “functional” entheses (i.e., anatomical regions where tendons or ligaments wrap around bony pulleys). Summary US has the potential to be the first-line method in the assessment of enthesitis. In the present review we critically discussed the current definitions of US enthesitis, the scoring systems, and the main fields of application (i.e., the detection of enthesitis in PsA and psoriasis, the identification of different disease subsets, and the assessment of response to treatment).
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
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The transition from enthesis physiological responses in health to aberrant responses that underpin spondyloarthritis mechanisms. Curr Opin Rheumatol 2021; 33:64-73. [PMID: 33229975 DOI: 10.1097/bor.0000000000000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Despite immunology and translational therapeutics advances in inflammatory arthritis over the past two decades, the enthesis, which is the epicentric of the spondyloarthritis family pathological process, retains many mysteries because of tissue inaccessibility that hampers direct immune study. As entheses are subject to almost continuous mechanical stress and spondyloarthritis is linked to microdamage or injury and joint stress, it is cardinal to understand the physiological changes occurring within the entheses not only to be able to differentiate disease from health but also to understand the transition normal physiology break down and its merges into spondyloarthritis-related disease. RECENT FINDINGS Imaging has played a major role in understanding the enthesis in human. Remarkable insights from enthesis functioning and microdamage in normal and with ageing including those linked to body mass index is emerging. The impact of mechanical stress and degenerative conditions on the development of the secondary entheseal vascular changes is not understood. Of note, ultrasound studies in psoriasis have shown higher power Doppler changes compared to controls pointing towards a role for vascular changes in the development of enthesitis in psoriatic arthritis. SUMMARY The literature pertaining to normal entheses changes with age, microdamage and vascular changes in health is providing a roadmap for understanding of the enthesis and its potential role in evolution of spondyloarthritis including psoriatic arthritis.
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Roth J, Inbar-Feigenberg M, Raiman J, Bisch M, Chakraborty P, Mitchell J, Di Geso L. Ultrasound findings of finger, wrist and knee joints in Mucopolysaccharidosis Type I. Mol Genet Metab 2021; 133:289-296. [PMID: 34090760 DOI: 10.1016/j.ymgme.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/19/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Musculoskeletal findings in MPS can progress after enzyme replacement. Our aim was to examine synovial recesses, tendons, retinacula and pulleys using ultrasonography for structural and inflammatory changes. MATERIAL AND METHODS The wrist, metacarpophalangeal (MCP), proximal and distal interphalangeal (PIP and DIP) joints, the finger flexor tendons and the knee including entheses of quadriceps and patella tendons were assessed clinically. Ultrasonography of the various synovial recesses of the wrist as well as the extensor retinaculum, carpal tunnel, MCP, PIP and DIP joints of the second finger, extensor and flexor tendons, A1-5 pulleys and the knee joint including relevant entheses followed. Significance of differences between patient values and available normative data were assessed using t-tests. RESULTS Ultrasonography showed significant abnormal intraarticular material in the wrist without a clear distribution to synovial recesses and without effusions. Doppler signals were found in a perisynovial distribution and not intrasynovial as expected in in inflammatory arthritis. Findings were similar in the knee but not the fingers. Flexor and extensor tendons were also mostly normal in their structure but significant thickening of retinaculae and the flexor tendon pulleys was seen (p<0.0001 compared to normal). CONCLUSION MPS I patients showed intraarticular deposition of abnormal material in the wrist and knee but not in the finger joints where significant thickening of retinaculae/pulleys controlling tendon position was dominant. No ultrasound findings of inflammatory pathology were demonstrated but rather a secondary reaction to abnormal deposition and direct damage of GAG.
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Affiliation(s)
- Johannes Roth
- Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Michal Inbar-Feigenberg
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julian Raiman
- Department of Inherited Metabolic Disease, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Marg Bisch
- Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - John Mitchell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Luca Di Geso
- Ospedale Provinciale Madonna del Soccorso, Department of Internal Medicine, San Benedetto del Tronto, Marche, Italy
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Mathew AJ, Ganapati A, Panwar J, Koshy V, Desai A, Danda D. Magnetic Resonance Imaging evidence of Inflammation at Interphalangeal joint of Thumb - A distinct entity in psoriatic arthritis. Int J Rheum Dis 2021; 24:1467-1472. [PMID: 34181319 DOI: 10.1111/1756-185x.14156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to compare inflammation at the interphalangeal (IP) joint of thumb in patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), undifferentiated inflammatory arthritis (UIA), and in psoriasis patients without clinical arthritis (PsO) using low-field magnetic resonance imaging (MRI). METHODS Age-matched and disease duration-matched patients with inflammatory arthritis (RA, PsA, and UIA) and psoriasis patients without clinical arthritis (PsO), who had undergone MRI of hands were included in this study. The presence or absence of MRI inflammatory lesions including synovitis, tenosynovitis, and bone marrow edema was assessed by three independent readers. Agreement between the readers was assessed using the intraclass correlation coefficient. Risk ratio of MRI global inflammation around thumb IP joints among patients with PsA was compared with the other groups. RESULTS Clinical parameters and MRI inflammation were studied in 161 patients (42 PsA, 28 RA, 29 UIA, and 62 PsO). Global MRI inflammation at the IP joint of the thumb was observed in 33.3% of PsA patients compared with 14.3% in RA, and 10.3% in UIA. Subclinical MRI inflammation was observed in 8.1% of patients with PsO. The risk ratios of MRI global inflammation at the IP joint of the thumb in PsA patients were 2.3 (95% confidence interval [CI] 0.86-6.36) and 3.2 (95% CI 1.02-10.21) compared with RA and UIA patients, respectively. CONCLUSION Global MRI inflammation around the IP joint of the thumb is significantly more common in patients with PsA as compared to individuals with UIA.
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Affiliation(s)
- Ashish J Mathew
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Arvind Ganapati
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - Varghese Koshy
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India.,Department of Rheumatology and Clinical Immunology, Command Hospital (Central Command), Lucknow, India
| | - Anu Desai
- Department of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
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Psoriatic Dactylitis: Current Perspectives and New Insights in Ultrasonography and Magnetic Resonance Imaging. J Clin Med 2021; 10:jcm10122604. [PMID: 34204773 PMCID: PMC8231617 DOI: 10.3390/jcm10122604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023] Open
Abstract
Dactylitis, one of the most typical features of psoriatic arthritis (PsA), is the diffuse swelling of the digits and is determined by the involvement of different anatomic structures, including: the subcutaneous fibrous tissue “accessory pulley” system; flexor tendons, with their related structures; the articular synovium; the small enthesis of the hands. Dactylitis is currently considered both a marker of disease activity and severe prognosis and its importance in PsA is emphasized by the inclusion in the classification criteria of PsA. This review focuses on the role of imaging in the management of PsA patients with dactylitis in clinical practice and in a research setting. Furthermore, imaging could be a valuable tool to assist in unravelling some of the underlying mechanisms of the onset and chronicization of dactylitis in PsA patients.
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Nakamura A, Haroon N. Recent Updates in the Immunopathology of Type 3 Immunity-Mediated Enthesitis. Curr Rheumatol Rep 2021; 23:31. [PMID: 33893896 DOI: 10.1007/s11926-021-00995-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Enthesitis is a cardinal feature of spondyloarthritis (SpA). Despite increasing available treatments, challenges remain in adequately controlling inflammation and subsequent new bone formation (NBF) in entheses; thus, a better understanding of the immunopathogenesis is warranted. RECENT FINDINGS Increasing evidence has identified immune cells playing key roles in enthesitis such as γδ T cells and group 3 innate lymphoid cells (ILC3), possibly with site-specific regulatory systems. The presence of T cells producing interleukin (IL)-17 independent of IL-23 in human spinal entheses was recently reported, which may corroborate the discrepancy between recent clinical trials and pre-clinical studies. In addition, the contribution of myeloid cells has also been focused in both human and pre-clinical SpA models. Moreover, not only the IL-23/IL-17 signaling, but other key type 3 immunity mediators, such as IL-22 and granulocyte-macrophage colony-stimulating factor (GM-CSF), have been reported as pivotal cytokines in inflammation and NBF of entheses. Immune cells demonstrating distinct features orchestrate entheses, leading to the complex landscape of enthesitis. However, recent advances in understanding the immunopathogenesis may provide new therapeutic targets and future research directions.
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Affiliation(s)
- Akihiro Nakamura
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.,Spondylitis Program, University Health Network, Toronto, Ontario, Canada.,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada. .,Spondylitis Program, University Health Network, Toronto, Ontario, Canada. .,Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,Division of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. .,Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Belman S, Walsh JA, Carroll C, Milliken M, Haaland B, Duffin KC, Krueger GG, Feng BJ. Psoriasis Characteristics for the Early Detection of Psoriatic Arthritis. J Rheumatol 2021; 48:1559-1565. [PMID: 33858978 DOI: 10.3899/jrheum.201123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Delays in the diagnosis and treatment of psoriatic arthritis (PsA) are common. These delays contribute to impairments in quality of life and joint damage. This study aims to calculate the incidence rate of PsA over time and identify clinical features that may be used for PsA prediction in patients with psoriasis (PsO). METHODS The study population for PsA incidence analysis included 1128 participants enrolled in the Utah Psoriasis Initiative between 2002 and 2014. Clinical evaluation and medical record review were performed to identify new cases of PsA after enrollment. To identify PsO features associated with PsA, the population was restricted to 627 participants who did not have PsA before PsO phenotyping and had been followed up for subsequent PsA diagnosis. We conducted Cox proportional hazard regressions to estimate the HR of PsA associated with PsO characteristics and other health-related features. RESULTS PsA incidence rate increased for > 60 years following PsO onset (trend P < 0.0001). There was a significant association between PsA and induration severity in untreated lesions (P < 0.001, HR 1.46), history of fingernail involvement (P < 0.001, HR 2.38), pustular PsO (P < 0.001, HR 3.32), fingernail involvement at enrollment (P < 0.001, HR 2.04), and Koebner phenomenon (P < 0.001, HR 1.90). Multivariate analysis yielded a model that included a history of fingernail involvement (P < 0.001, HR 2.16) and untreated induration (P < 0.001, HR 1.41). CONCLUSION Risk of PsA increases steadily for > 60 years following PsO onset. Patient-reported history of PsO characteristics has greater predictive power than physician-measured features at enrollment visits. The characteristics identified in this study provide guidance for screening for PsA risk in patients with PsO.
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Affiliation(s)
- Sophie Belman
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Jessica A Walsh
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Courtney Carroll
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Michael Milliken
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Benjamin Haaland
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Kristina C Duffin
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Gerald G Krueger
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
| | - Bing-Jian Feng
- This study was partially supported by the 2019 Discovery Research Grant and Psoriatic Arthritis Diagnostic Test Grant from the National Psoriasis Foundation, the 2018 Immunology, Inflammation, and Infectious Diseases 3i Initiative at the University of Utah, and Pfizer Inc. (grant numbers WI227108 and WI240276). The support and resources from the Center for High-Performance Computing at the University of Utah are gratefully acknowledged. The computational resources used were partially funded by the National Institutes of Health (NIH) Shared Instrumentation Grant 1S10OD021644-01A1. This project utilized REDCap at the University of Utah, supported by grant 8UL1TR000105 ( formerly UL1RR025764) from the National Center for Advancing Translational Sciences and NIH. S. Belman, MSc, School of Medicine, University of Utah, Salt Lake City, Utah, USA, and Wellcome Sanger Institute, University of Cambridge, Hinxton, UK; J.A. Walsh, MD, C. Carroll, MSc, M. Milliken, MD, MPH, K. Callis Duffin, MD, G.G. Krueger, MD, School of Medicine, University of Utah, Salt Lake City, Utah, USA; B. Haaland, PhD, B.J. Feng, PhD, School of Medicine, and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. The PERCH software, for which BJF is the inventor, has been nonexclusively licensed to Ambry Genetics Corporation for their clinical genetic testing services and research. BJF also reports funding and sponsorship to his institution on his behalf from Pfizer Inc., Regeneron Genetics Center LLC., and AstraZeneca. BH has consulted for the National Kidney Foundation and Value Analytics Labs. The remaining authors declare no potential conflicts of interest relevant to this article. Address correspondence to Dr. B.J. Feng, 30 N 1900 E, Department of Dermatology, Salt Lake City, UT 84132, USA. . Accepted for publication March 29, 2021
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Tinazzi I, McGonagle D, Macchioni P, Aydin SZ. Power Doppler enhancement of accessory pulleys confirming disease localization in psoriatic dactylitis. Rheumatology (Oxford) 2021; 59:2030-2034. [PMID: 31794000 DOI: 10.1093/rheumatology/kez549] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The digital accessory pulleys are highly mechanically stressed mini-entheses that are thickened in patients with a history of PsA-related dactylits. This study explored whether these pulleys are involved in PsA dactylitis as assessed by intra-pulley US power Doppler changes. METHODS Fifty-eight PsA patients with dactylitis had US of the second to fourth digits for pulleys of the dactylitic and contralateral digits. The Leeds Dactylometer was used for thickness measurement. The presence of digital pain, tenderness, and swelling in the dactylitis finger and in the contralateral side was evaluated. RESULTS We recruited 34 patients with acute and 24 patients with chronic dactylitis, 45/58 (77%) of which had tenderness on clinical assessment. Intra-pulley power Doppler was more frequently found in the dactylitic digits compared with contralateral sides and linked to A1, A2 and A4 pulleys thickening [power Doppler signals in A1 pulley (51%), A2 (22%) and A4 (12%) in dactylitic digit; compared with 1 A1, A2 and A4 pulleys each in the contralateral side (1.7%)]. Almost all cases had peri-tendinous oedema, and 82.6% of dactylitic digits had flexor tenosynovitis with power Doppler signals in 65.2% of flexor tendons. CONCLUSION Despite their small size and relatively avascular, the accessory pulleys exhibit power Doppler change in active Psoriatic dactylitis, supporting a pivotal role in dactylitis-related tenosynovitis and extra-tendinous disease.
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Affiliation(s)
- Ilaria Tinazzi
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and The University of Leeds, Leeds, UK
| | | | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Min HK, Cho H, Park SH. Characteristics of Post-traumatic-spondyloarthritis: A Cross-sectional Study From a Single Tertiary Hospital. JOURNAL OF RHEUMATIC DISEASES 2021; 28:25-30. [PMID: 37476388 PMCID: PMC10324953 DOI: 10.4078/jrd.2021.28.1.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 07/22/2023]
Abstract
Objective Trauma has been proposed as a triggering factor of psoriatic arthritis (PsA), and the deep Koebner phenomenon was the suggested underlying mechanism The relationship between spondyloarthritis (SpA) and trauma was only observed in PsA This study investigated cases of SpA other than PsA that occurred after physical trauma and analyzed their clinical, laboratory, and radiologic features. Methods We retrospectively reviewed the medical records of 213 patients who visited our hospital due to a suspicion of SpA and grouped them into post-traumatic-SpA (PT-SpA, n=12) and non-post-traumatic-SpA (non-PT-SpA, n=201) Baseline characteristics were compared between the two groups by cross-sectional manner. Results Peripheral SpA was more common in PT-SpA than in non-PT-SpA Active inflammation on sacroiliac joint (SIJ) magnetic resonance imaging (MRI) was more common in non-PT-SpA (835% vs 545%, p=0046) The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) was significantly higher in the non-PT-SpA group (20 vs 00, p=0007) Symptom duration from the first SpA symptom to diagnosis tends to be longer in the non-PT-SpA group (20 vs 05 years, p=0079). Conclusion PT-SpA patients more frequently showed peripheral SpA, a less active inflammatory lesion on SIJ MRI, and a lower mSASSS score Further studies are needed to clarify whether physical trauma has a direct/indirect role in the pathogenesis of SpA or merely confers an opportunity to recognize SpA symptoms.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hyonjoung Cho
- Division of Rheumatology, Department of Internal Medicine, Armed Forces Capital Hospital, Armed Forces Medical Command, Seongnam, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Li KJ, Tsai TF, Lo Y, Wang TS. Correlation of clinical diagnosis of dactylitis by the dermatologist and ultrasonographic diagnosis by the rheumatologist in patients with psoriasis arthritis: Experience of a single clinic. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_53_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Girolimetto N, Zabotti A, Tinazzi I, Possemato N, Costa L, Batticciotto A, Canzoni M, Citriniti G, Lucia OD, Figus F, Idolazzi L, McConnel R, Peluso R, Sakellariou G, Tullio A, Salvarani C, Scarpa R, Iagnocco A, Caso F, Macchioni P. Sensitivity to change and clinical correlations of the novel DACtylitis glObal Sonographic (DACTOS) score in psoriatic arthritis. Rheumatology (Oxford) 2020; 60:4103-4111. [PMID: 33369655 DOI: 10.1093/rheumatology/keaa885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/25/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of the study is to assess the performance of the DACTOS (DACtylitis glObal Sonographic) score in a PsA dactylitis clinical setting. In particular, we evaluated the ability of DACTOS to identify the affected fingers, its sensitivity to change after treatment, the correlations between DACTOS and clinical parameters, and the capacity of the score to identify the treatment responders. METHODS Forty-six consecutive patients with symptomatic PsA hand dactylitis were enrolled. A total of seventy-three dactylitic digits were evaluated clinically and sonographically before and after treatment in this observational and prospective study. Clinical assessment included the Leeds Dactylitis Index-basic (LDI-b) score and visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). Sonographic lesions were investigated using high-frequency ultrasound with grey scale and power Doppler features according to the DACTOS score. Correlations between the DACTOS score and the clinical parameters were assessed at baseline, 1 month (T1) and 3 months (T3). RESULTS We observed significant improvements in all of the assessed clinical parameters and the DACTOS scores after dactylitis treatment. There was a statistically significant correlation between the variation of all clinical parameters (VAS-p, VAS-FI and LDI-b) and the DACTOS score at T1 and T3 evaluations. We found statistically significant differences in the DACTOS score between clinical responder and non-responder groups (P < 0.001) and between clinical remission and non-remission groups (P < 0.001). CONCLUSION The DACTOS score performs well in real-life clinical settings in terms of sensitivity to change and correlations with clinical features in PsA dactylitis.
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Affiliation(s)
- Nicolò Girolimetto
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia.,Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, University of Udine
| | - Ilaria Tinazzi
- IRCSS Ospedale Sacro Cuore Don Calabria, Unit of Rheumatology, Negrar, Verona
| | - Niccolò Possemato
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - Alberto Batticciotto
- Department of Internal Medicine, Rheumatology Unit, ASST-Settelaghi 'Ospedale di Circolo-Fondazione Macchi', Varese
| | | | - Giorgia Citriniti
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
| | - Orazio De Lucia
- Department of Rheumatology and Medical Sciences, UOC of Clinical Rheumatology, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan
| | - Fabiana Figus
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, MFRU, Turin
| | - Luca Idolazzi
- Rheumatology Unit, University of Verona, Ospedale Civile Maggiore, Verona
| | - Rebecca McConnel
- Department of Surgical Sciences, Università degli Studi di Torino, Turin
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - Garifallia Sakellariou
- Division of Rheumatology, University of Pavia, Istituti Clinici Scientifici Maugeri, Pavia
| | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Carlo Salvarani
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, MFRU, Turin
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples
| | - Pierluigi Macchioni
- Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia
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Abstract
OBJECTIVE. The purpose of this article is to cover technical advances in musculo-skeletal ultrasound from the viewpoint of the radiologist. CONCLUSION. Among the advances in musculoskeletal ultrasound that we highlight the use of ultrahigh-frequency transducers to visualize ever-finer anatomic detail, the expanding practical clinical applications for microvascular imaging, and the use of elastography to predict function and, possibly, healing potential.
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Fassio A, Matzneller P, Idolazzi L. Recent Advances in Imaging for Diagnosis, Monitoring, and Prognosis of Psoriatic Arthritis. Front Med (Lausanne) 2020; 7:551684. [PMID: 33195301 PMCID: PMC7658536 DOI: 10.3389/fmed.2020.551684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory condition characterized by a strong heterogeneity and multifaceted behavior. PsA manifests in two types—axial and peripheral—which may be present at the same time. Peripheral manifestations can be further divided into the articular (arthritis) and extra-articular (i.e., enthesitis and dactylitis) subgroups. In such a complex disease, imaging is often required to characterize the type of involvement and to evaluate the radiological damage and progression of PsA. In addition, imaging plays a pivotal role in clinical practice; that is, for axial involvement. Conventional radiology has been the main standard of reference for many years. However, in recent years, there has been growing interest in different imaging modalities, such as ultrasonography (US) and magnetic resonance imaging (MRI). All these techniques play a role in the diagnosis and follow-up of patients with PsA and cover all the types of the disease. US and MRI have good sensitivities and specificities for detecting synovitis, and this may be helpful for differential diagnosis with other musculoskeletal diseases and useful in the early or preclinical phases of the disease. However, US is not useful in the diagnosis of axial PsA. In addition, other modalities have been investigated in the field of PsA imaging. Computed tomography (CT), in particular, dual energy-CT and high-resolution peripheral CT (HRpQ-CT) might play an important role in the assessment of bone damage, erosions, and new bone formation. Regarding advanced functional imaging, FDG PET/CT is another interesting technique for exploring disease activity.
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Affiliation(s)
- Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
- *Correspondence: Angelo Fassio
| | - Peter Matzneller
- Rheumatology Service, South Tyrolean Health Trust, Silandro Hospital, Silandro, Italy
| | - Luca Idolazzi
- Rheumatology Unit, University of Verona, Verona, Italy
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Aydin SZ, Mathew AJ, Koppikar S, Eder L, Østergaard M. Imaging in the diagnosis and management of peripheral psoriatic arthritis. Best Pract Res Clin Rheumatol 2020; 34:101594. [PMID: 33032929 DOI: 10.1016/j.berh.2020.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Psoriatic arthritis is a heterogenous disease affecting peripheral and axial joints, tendons, ligaments, and their insertions, in addition to the skin and the nails. The complexity of the involved structures has puzzled clinicians trying to understand the underlying pathology that leads to symptoms in order to choose the appropriate medications with different modes of actions. Imaging, mainly ultrasound and magnetic resonance imaging, allows of accurate detection of inflammatory changes in the musculoskeletal structures, which helps to avoid false positive and negative assessments. The linking of different anatomical structures' involvement using imaging also provides insights into the pathogenesis of psoriatic arthritis. In this review, ultrasound and magnetic resonance imaging will be discussed in depth with regard to their use in the field of peripheral psoriatic arthritis, with a focus on the literature from the last 4 years and recent advances.
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Affiliation(s)
- Sibel Zehra Aydin
- University of Ottawa Faculty of Medicine, Rheumatology, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.
| | - Sahil Koppikar
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Lihi Eder
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Musculoskeletal Ultrasound in Monitoring Clinical Response to Treatment in Acute Symptomatic Psoriatic Dactylitis: Results from a Multicentre Prospective Observational Study. J Clin Med 2020; 9:jcm9103127. [PMID: 32992634 PMCID: PMC7601129 DOI: 10.3390/jcm9103127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023] Open
Abstract
This observational and prospective study evaluated the clinical correlations of sonographic lesions in consecutive psoriatic arthritis (PsA) dactylitis cases. Eighty-three dactylitic digits were evaluated clinically and sonographically before treatment and at one-month (T1) and three-month (T3) follow-up. Clinical evaluation included the Leeds Dactylitis Index-basic (LDI-b) score and the visual analogue scales for pain (VAS-p) and functional impairment (VAS-FI). High-frequency ultrasound with grey scale (GS) and power Doppler (PD) assessed flexor tenosynovitis (FT), soft tissue oedema (STO), extensor tendon paratenonitis, and joint synovitis. There was a statistically significant correlation between the clinical parameters (VAS-p, VAS-FI, and LDI-b) and FT and STO at T1 and T3. We found statistically significant improvement in FT and STO for the cases with clinically meaningful treatment responses (p < 0.001). After a multiple conditional logistic regression analysis, the only variables that correlated with a T1 clinical response were the resolutions of PD FT (OR 15.66) and PD STO (OR 6.23), while the resolution of PD FT (OR 27.77) and of GS STO (OR 7.29) correlated with a T3 clinical response. The clinical improvements of active dactylitis are linked to the regression of sonographic evidence of extracapsular inflammation (particularly FT and STO).
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Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms. Biosci Rep 2020; 39:221063. [PMID: 31710084 PMCID: PMC6893164 DOI: 10.1042/bsr20193266] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/16/2022] Open
Abstract
Koebner phenomenon refers to the emergence of new psoriatic lesions in the healthy skin regions following an injury/trauma to psoriatic patients. The occurrence of psoriatic lesions at unusual areas of the body regions such as on penis, around eyes and on keloids suggest that the Koebner phenomenon may be responsible for these lesions. A number of agents/triggers have been reported to induce the development of new psoriatic lesions in healthy skin areas and these include, tattooing skin, radiations, skin incision, viral infections and striae etc. The different mechanisms that contribute in inducing the development of new psoriatic lesions as Koebernization include the involvement of mast cell-derived inflammatory mediators such as tryptase, IL-6, IL-8, IL-17, and IL-36γ. Moreover, an increased expression of nerve growth factor (NGF) and vascular endothelial growth factor (VEGF) also contribute in Koebernization. Apart from these, there is a critical role of α 2 β1 integrins, S100A7 (psoriasin) and S100A15 (koebnerisin), change in the ratio of CD4+/CD8+ T cells, down-regulation of mechanosensitive polycystin 1 protein, decrease in inflammation controlling atypical chemokine receptor 2 (ACKR2), reduced expression of N-methyl-d-aspartate (NMDA) receptors (NMDARs) on the keratinocytes and increase in levels of chemokines (CXCL8 and CCL20) in inducing formation of new psoriatic lesions. The present review discusses the role of Koebner phenomenon in the development of new psoriatic lesions. Moreover, it also describes the mechanisms involved in Koebernization in the form of discussion of different key targets that may be potentially modulated pharmacologically to attenuate/halt the development of new psoriatic lesions.
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Penkava F, Velasco-Herrera MDC, Young MD, Yager N, Nwosu LN, Pratt AG, Lara AL, Guzzo C, Maroof A, Mamanova L, Cole S, Efremova M, Simone D, Filer A, Brown CC, Croxford AL, Isaacs JD, Teichmann S, Bowness P, Behjati S, Hussein Al-Mossawi M. Single-cell sequencing reveals clonal expansions of pro-inflammatory synovial CD8 T cells expressing tissue-homing receptors in psoriatic arthritis. Nat Commun 2020; 11:4767. [PMID: 32958743 PMCID: PMC7505844 DOI: 10.1038/s41467-020-18513-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/27/2020] [Indexed: 11/08/2022] Open
Abstract
Psoriatic arthritis (PsA) is a debilitating immune-mediated inflammatory arthritis of unknown pathogenesis commonly affecting patients with skin psoriasis. Here we use complementary single-cell approaches to study leukocytes from PsA joints. Mass cytometry demonstrates a 3-fold expansion of memory CD8 T cells in the joints of PsA patients compared to peripheral blood. Meanwhile, droplet-based and plate-based single-cell RNA sequencing of paired T cell receptor alpha and beta chain sequences show pronounced CD8 T cell clonal expansions within the joints. Transcriptome analyses find these expanded synovial CD8 T cells to express cycling, activation, tissue-homing and tissue residency markers. T cell receptor sequence comparison between patients identifies clonal convergence. Finally, chemokine receptor CXCR3 is upregulated in the expanded synovial CD8 T cells, while two CXCR3 ligands, CXCL9 and CXCL10, are elevated in PsA synovial fluid. Our data thus provide a quantitative molecular insight into the cellular immune landscape of psoriatic arthritis.
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MESH Headings
- Arthritis, Psoriatic/blood
- Arthritis, Psoriatic/immunology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- Clonal Selection, Antigen-Mediated
- Gene Expression Profiling
- Humans
- Immunologic Memory
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Receptors, Chemokine/metabolism
- Receptors, Lymphocyte Homing/genetics
- Receptors, Lymphocyte Homing/metabolism
- Single-Cell Analysis
- Synovial Fluid/immunology
- Synovial Membrane/immunology
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Affiliation(s)
- Frank Penkava
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | | | | | - Nicole Yager
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Lilian N Nwosu
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Alicia Lledo Lara
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | | | - Ash Maroof
- UCB Pharma, 216 Bath road, Slough, SL1 3WE, UK
| | | | | | | | - Davide Simone
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Andrew Filer
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Institute of Inflammation and Ageing, Birmingham, UK
| | - Chrysothemis C Brown
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Andrew L Croxford
- Idorsia Pharmaceuticals Ltd., Drug Discovery Immunology, Hegenheimermattweg 91, 4123, Allschwill, Switzerland
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | | | - Paul Bowness
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton, CB10 1SA, UK.
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0SP, UK.
| | - M Hussein Al-Mossawi
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
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Gazel U, Solmaz D, Ayan G, Ivory C, Karsh J, Aydin SZ. Accuracy of Physical Examination to Detect Synovial and Extra-Synovial Pathologies in Psoriatic Arthritis in Comparison to Ultrasonography. J Clin Med 2020; 9:jcm9092929. [PMID: 32927920 PMCID: PMC7564699 DOI: 10.3390/jcm9092929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022] Open
Abstract
We aimed to explore the accuracy of physical examination (PE) to detect the synovial and extra-synovial pathologies in psoriatic arthritis (PsA) in comparison to ultrasonography (US). Twenty-nine PsA patients with hand pain were included in the study. A detailed PE of the hands was performed and US scans were performed for the joints, extensor and flexor tendons, and entheses of the second to fifth fingers of both hands. The agreement between PE and US findings was calculated. The strongest agreement for the joints was between "swollen joints" and power Doppler (PD) signals in the metacarpophalangeal (MCP) joints and grey scale synovitis in the proximal interphalangeal (PIP) joints. The agreement of tender entheses on PE and inflammation on US (hypoechogenicity, thickening, and/or PD signals) was poor for both extensor (Kappa = -0.027, Prevalence Adjusted and Bias Adjusted Kappa (PABAK) = 0.344) and flexor compartments (Kappa = 0.039, PABAK = 0.569). Similar to enthesitis, comparison of any PE and US findings showed a poor agreement at the extensor and flexor tendon regions (extensor: Kappa = 0.123, PABAK = 0.448, and flexor: Kappa = 0.171, PABAK = 0.431). Our study showed that there was a poor to fair agreement of PE and US findings of hands. US can add value when determining the source of pain in PsA in the small joints.
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Affiliation(s)
- Ummugulsum Gazel
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
- Correspondence:
| | - Dilek Solmaz
- Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Cigli, Izmir 35620, Turkey;
| | - Gizem Ayan
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
| | - Catherine Ivory
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
| | - Jacob Karsh
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
| | - Sibel Zehra Aydin
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 7W9, Canada; (G.A.); (C.I.); (J.K.); (S.Z.A.)
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON K1H 7W9, Canada
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Marzo-Ortega H, Tan AL, McGonagle D, Pickles D, Dubash S, Vandevelde CY, Coates LC, Siebert S, Helliwell PS. BSR Spondyloarthritis Course, 27 February 2020. Spondyloarthritis: pathogenesis, diagnosis and management. Rheumatol Adv Pract 2020; 4:rkaa043. [PMID: 33005861 PMCID: PMC7519775 DOI: 10.1093/rap/rkaa043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
High-quality continuous medical education is essential to maintain excellence in health-care delivery, upskilling professionals and improving patient outcomes. This is particularly relevant when addressing rare disease groups, such as the spondyloarthritides, a group of heterogeneous inflammatory conditions that affect joints and other organs, such as the skin, bowel and eye. Professional bodies, such as the British Society for Rheumatology (BSR), are well placed to deliver this type of education. In 2020, the BSR ran a dedicated SpA course aimed at rheumatology health-care professionals wishing to update their basic knowledge of SpA with a review of the latest advances in the field. Here, we summarize the proceedings of the meeting and discuss the value of such an initiative.
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Affiliation(s)
- Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - David Pickles
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
| | - Sayam Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Claire Y Vandevelde
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Philip S Helliwell
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
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Dubash SR, De Marco G, Wakefield RJ, Tan AL, McGonagle D, Marzo-Ortega H. Ultrasound Imaging in Psoriatic Arthritis: What Have We Learnt in the Last Five Years? Front Med (Lausanne) 2020; 7:487. [PMID: 32984374 PMCID: PMC7477070 DOI: 10.3389/fmed.2020.00487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/17/2020] [Indexed: 12/13/2022] Open
Abstract
Psoriatic arthritis (PsA) is a complex heterogeneous disease with multiple inter-related pathologies such as synovitis, enthesitis, tendinopathy, and dactylitis. Clinical assessment is limited in its detail to assess pathology, thus in recent years, ultrasound (US) has become more popular, given its high sensitivity to detect inflammatory arthritis and ability to inform clinical decisions. Although a qualitative technique, US findings can be graded semi-quantitatively for grayscale (GS) and power Doppler (PD). Synovitis is frequently present in inflammatory arthritis pathologies, and in PsA, recent evidence shows a propensity for tendon and entheseal lesions. The presence of flexor tenosynovitis and flexor tendon insertional enthesopathy at accessory pulleys is supportive of the “Deep Koebner” concept. Peri-tendinous inflammation—mutual to PsA or rheumatoid arthritis (RA), is associated with soft tissue oedema with PD signal frequently at the flexor tendon compartments in PsA. Research on enthesitis in PsA/PsO has improved understanding in subclinical and clinical PsA, explored associations with progression to PsA, and investigated links to prognosis assessment. Dactylitis is a pathognomonic PsA lesion where US has enhanced knowledge of the disease course and pathology of lesions such as: flexor tenosynovitis; synovitis; and soft tissue oedema. Increased US sensitivity has also brought innovation including promising automated ultrasound scanning techniques. So, what have we learnt in recent years and what are the unmet needs to focus future research initiatives in this disabling disease? This narrative review article assesses the neoteric evidence, bringing into context the knowledge gained and highlighting potential areas of research.
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Affiliation(s)
- Sayam R Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Gabriele De Marco
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Richard J Wakefield
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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Kaeley GS. Visualization of Enthesitis by Ultrasound: a Key Diagnostic Tool in Spondyloarthropathy Diagnosis and Management. Curr Rheumatol Rep 2020; 22:48. [PMID: 32696194 DOI: 10.1007/s11926-020-00927-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to report on the current status of evaluation of enthesitis with sonography. Sonography can visualize peripheral entheses in great detail since most of them are superficial. Visualization of entheses has provided insights into the pathophysiology of enthesitis and highlighted the interconnectivity of stress dissipation mechanisms about the enthesis. The primary use of entheseal sonography presently revolves around diagnostic use. RECENT FINDINGS There is increasing awareness of biomechanical confounders that lead to entheseal changes, which are more prevalent in males, patients with higher body mass index, and those who are more active-though there are several approaches to mitigate biomechanical confounders in sonographic evaluation. Entheseal sonography may also provide prognostic information in predicting the severity of axial syndesmophyte formation. Although entheseal outcome scoring systems are available, there is sparse data on its use as an outcome tool, and hence, this is a fertile area for future research.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA.
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Di Matteo A, Mankia K, Azukizawa M, Wakefield RJ. The Role of Musculoskeletal Ultrasound in the Rheumatoid Arthritis Continuum. Curr Rheumatol Rep 2020; 22:41. [PMID: 32562012 PMCID: PMC7305070 DOI: 10.1007/s11926-020-00911-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is no longer considered a fixed phenotype but rather a disease continuum. This review outlines the current and potential value of applying ultrasound (US) along this continuum: from the prediction of progression to RA in at-risk individuals, to confirmation of the early diagnosis of RA, as well as the consideration of differential diagnoses, and the use in disease monitoring and defining remission. RECENT FINDINGS In individuals at-risk of RA (i.e., positive autoantibodies with symptoms but without synovitis), US has shown a promising predictive value for the development of clinical arthritis, providing the opportunity to improve risk stratification (and disease prevention) of these individuals. The detection of inflammation on US in patients with early undifferentiated arthritis, in which a definite diagnosis cannot be reached, could predict evolution to persistent arthritis, mostly RA. This, in addition to the US potential ability to identify disease specific patterns for different rheumatic conditions, might facilitate early diagnosis and, therefore, improve the management of patients with RA, or other types of inflammatory arthritides. US has also demonstrated the capability to predict radiographic progression, and relapse risk after treatment discontinuation, in RA patients in remission according to the clinical instruments, raising implications in the management, including therapy discontinuation, of these patients. US has an undeniable value in the management of patients at different stages along the RA continuum. Further research is needed to identify which groups of patients benefit the most from US imaging.
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Affiliation(s)
- Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Rheumatology Unit, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Masayuki Azukizawa
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Orthopaedic Surgery, Himeji Medical Center, 68 Honmachi, Himeji, Hyogo, 670-8520, Japan
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Smerilli G, Cipolletta E, Di Carlo M, Di Matteo A, Grassi W, Filippucci E. Power Doppler Ultrasound Assessment of A1 Pulley. A New Target of Inflammation in Psoriatic Arthritis? Front Med (Lausanne) 2020; 7:204. [PMID: 32582725 PMCID: PMC7290420 DOI: 10.3389/fmed.2020.00204] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022] Open
Abstract
Objective: To determine the prevalence of grey scale and power Doppler (PD) ultrasound (US) features of A1 pulley inflammation in a cohort of psoriatic arthritis (PsA) patients compared with rheumatoid arthritis (RA) patients. Methods: Sixty patients (30 with PsA and 30 with RA) were consecutively enrolled. The main clinimetric indexes were recorded, and US assessment of A1 pulleys from second to fifth fingers bilaterally was carried out. The presence of A1 pulley inflammation, defined as PD signal within a thickened pulley, was registered. Results: A1 pulley inflammation was found in 15 of 240 fingers (6.3%) of eight PsA patients (26.7%) and in one of 240 fingers (0.4%) of one RA patient (3.3%) (p < 0.01 and p = 0.03, respectively). Seven of eight PsA patients (88%) with at least one inflamed A1 pulley had a moderate/high disease activity score. The regression linear analysis (R2 = 0.36, adjusted R2 = 0.31) showed that A1 pulley inflammation was correlated with Disease Activity Index for Psoriatic Arthritis (DAPSA) (β = 0.43, p = 0.03). Conclusion: US A1 pulley inflammation appears to be relatively common at patient level in PsA, seems to be a characteristic feature of PsA compared to RA, and correlates with DAPSA.
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy
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Zabotti A, Tinazzi I, Aydin SZ, McGonagle D. From Psoriasis to Psoriatic Arthritis: Insights from Imaging on the Transition to Psoriatic Arthritis and Implications for Arthritis Prevention. Curr Rheumatol Rep 2020; 22:24. [PMID: 32418006 PMCID: PMC7230038 DOI: 10.1007/s11926-020-00891-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To describe the recent advances in the field towards the prevention and early recognition of Psoriatic Arthritis (PsA). RECENT FINDINGS Defining the preclinical phase of PsA remains challenging since up to 50% of subjects with psoriasis have subclinical imaging enthesopathy, but many of these do not progress to PsA. Nevertheless, there is evidence that subjects with subclinical imaging enthesopathy are at increased risk of developing PsA. In recent years, it has been shown that both PsA and anti-citrullinated protein antibodies (ACPA) positive rheumatoid arthritis (RA) are characterized by a subclinical phase of non-specific or brief duration arthralgia with shared imaging features accounting for joint symptomatology. Sonographically determined tenosynovitis and enthesitis are the key imaging features present in non-specific PsO arthralgia that are at risk of future PsA development. Furthermore, the early phases of PsA are complicated by factors including body mass index (BMI), which is a risk factor for PsA, but BMI is also associated with imaging abnormalities on enthesopathy. Fully disentangling these clinical and imaging factors will be important for enrichment for imminent PsA so that disease prevention strategies can be investigated. Psoriasis patients with arthralgia have a higher prevalence of tenosynovitis and imaging enthesopathy is at higher risk of transitioning to overt PsA.
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Affiliation(s)
- Alen Zabotti
- Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Sibel Zehra Aydin
- Faculty of Medicine, Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
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Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int 2020; 40:837-848. [PMID: 32211929 DOI: 10.1007/s00296-020-04559-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/14/2020] [Indexed: 01/08/2023]
Abstract
Many rheumatic diseases may present with an inflammatory joint syndrome, affecting the small joints of the hands, of which rheumatoid (RA) and psoriatic arthritis (PsA) being one of the most common. The aim of this systematic review was to focus on the literature evidence regarding the added value of ultrasound (US) of the hand in the differential diagnosis between RA and PsA. Pubmed and Scopus were searched to identify original manuscripts, published in the last 20 years utilising ultrasonography to reveal specific hand US patterns. Studies were eligible if they: (1) included adults (over 18 years) with a diagnosis of RA/PsA; (2) were published in the English language; (3) were published in peer-reviewed journals; (4) included description of the US machine; (5) used US for assessment of hand joints, periarticular tissues and nails. The search yielded 322 published studies, of which 16 were deemed relevant and were included in the present study. Overall, there was heterogeneity with regard to the pathology examined. Based on the included studies analysis, hand US patterns have several basic features to be considered-location of gray scale (GS) inflammatory findings, involvement of periarticular soft tissue, distribution and extent of Doppler signal (intra- and peri-articular), bone reaction, shape and location of erosions, involvement of tendons without synovial sheath, involvement of enthesis and nail abnormalities. Future research could focus on determining the sensitivity and specificity of the different US detected hand patterns in patients with early arthritis.
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Affiliation(s)
- Tanya Sapundzhieva
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria. .,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria.
| | - Rositsa Karalilova
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria.,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria.,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria
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Abrar DB, Schleich C, Nebelung S, Frenken M, Radke KL, Vordenbäumen S, Brinks R, Schneider M, Ostendorf B, McGonagle D, Sewerin P. High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis. Arthritis Res Ther 2020; 22:40. [PMID: 32122392 PMCID: PMC7052970 DOI: 10.1186/s13075-020-2135-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel high-resolution hand coil. Methods Seventeen patients with active PsA, 20 patients with active RA, and 16 healthy controls (HC) underwent high-resolution 3 T MRI using the dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, thickness of flexor tendon pulleys, and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores. For correlation analyses, Spearman rho correlation was calculated. Results Flexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm, p < 0.001) and HC (mean difference 0.2 mm, p < 0.001) and showed a higher degree of associated inflammatory changes (mean difference from RA 4.7, p = 0.048; mean difference from HC 14.65, p < 0.001). Additionally, there was a strong correlation of accessory pulley inflammation and PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis, and periarticular inflammation (for the second digit synovitis ρ = 0.72, flexor tenosynovitis ρ = 0.7, overall PsAMRIS ρ = 0.72, p < 0.01). Similar robust correlations were evident in digits 3–5. Weaker correlations were evident in RA (synovitis ρ = 0.49, flexor tenosynovitis ρ = 0.49, periarticular inflammation ρ = 0.4). Conclusion The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection in PsA, as well as for its distinction from RA and HC. Trial registration 2014123117, December 2014.
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Affiliation(s)
- Daniel B Abrar
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Schleich
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Sven Nebelung
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Miriam Frenken
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralph Brinks
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and The University of Leeds, Leeds, UK
| | - Philipp Sewerin
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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McGonagle D, Tan AL, Watad A, Helliwell P. Pathophysiology, assessment and treatment of psoriatic dactylitis. Nat Rev Rheumatol 2020; 15:113-122. [PMID: 30610219 DOI: 10.1038/s41584-018-0147-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dactylitis is diffuse swelling of the digits that is usually related to an underlying inflammatory or infiltrative disorder. Psoriatic arthritis (PsA) is the most common severe disease thought to cause dactylitis. Our understanding of the pathogenesis of PsA-related dactylitis comes from experimental animal models of PsA-like disease, as well as advances in imaging and other clinical studies. Clinical trials in PsA have increasingly included dactylitis as an important secondary outcome measure. These studies indicate that cytokines drive multi-locus microanatomical pan-digital pathology. Given the importance of pro-inflammatory cytokines, the pathogenesis of dactylitis is best understood as an initial aberrant innate immune response to biomechanical stress or injury, with subsequent adaptive immune mechanisms amplifying the dactylitis inflammatory response. Regarding the treatment of dactylitis, no studies have been conducted using dactylitis as the primary outcome measure, and the current knowledge comes from analysis of dactylitis as a secondary outcome measure.
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Affiliation(s)
- Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK. .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Abdulla Watad
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Rheumatology department, Bradford Hospitals NHS Foundation Trust, Bradford, UK
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Psoriasis is an independent risk factor for entheseal damage in axial spondyloarthritis. Semin Arthritis Rheum 2020; 50:42-47. [DOI: 10.1016/j.semarthrit.2019.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/24/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022]
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