Clinical and ultrasound features of a cohort of psoriasis patients without musculoskeletal symptoms: a prospective and multicentre study.

Abstract

To evaluate clinical and ultrasound (US) features related to psoriatic arthritis (PsA) development in psoriasis (PsO), patients without musculoskeletal (MSK) symptoms and no systemic treatment. Prospective study including PsO patients followed by dermatologists. Clinical and US data were collected at baseline and during follow-up by rheumatologists. Seventy-eight patients with PsO were included. Mean disease duration was 15.1 years (SD ± 13.4); most had mild PsO (82%), onychopathy was present in 36 (39.7%) and overweight/obesity in 38 patients (48.7%). In the US evaluation, nine patients (11.5%) had Power Doppler grade 1 at joints, 56.4% had calcifications and 30.4% bursitis at enthesis. Sixty patients completed the study. After a median of 76.60 months (IQR 39.34-85.25), 34 patients (56.6%) developed MSK symptoms. They had higher BMI (P = 0.013), abdominal circumference (P = 0.022), scored higher for pain (P = 0.047) and fatigue (P = 0.011). Their baseline US showed a higher total US score (P = 0.037). Five patients (8.3%) developed MSK inflammatory symptoms, and four met CASPAR criteria (5.5%). The mean time from baseline to PsA diagnosis was 20.20 months (SD ± 12.02). US bursitis was present in 80% of patients developing inflammatory symptoms (P = 0.049). In a cohort of patients with mild PsO, systemic therapy-naive and no MSK symptoms, incidence of PsA was 1% per year. US bursitis at enthesis was related to the development of symptoms suggestive of PsA. Patients who developed MSK symptoms had higher BMI, fatigue and pain VAS scores at baseline and could constitute a subgroup with higher risk for transition to PsA.