Association of Contextual Factors With Sonographic Inflammatory and Structural Phenotypes in Patients With Psoriatic Arthritis: A Cross-Sectional Study.

Abstract

Ultrasound (US) can enhance psoriatic arthritis (PsA) disease activity assessment, but the effect of contextual factors on sonographic findings in PsA remains unclear. This study examined how demographic and clinical factors affect sonographic lesions in active PsA. This was a cross-sectional study of 115 patients with active PsA who underwent US evaluation for synovitis, enthesitis, paratenonitis, tenosynovitis, joint bone erosion, and new bone formation (NBF). Lesions were scored semiquantitatively with B-mode and Doppler using a 64-joint, 16-enthesis, and 34-tendon US protocol. Total scores were analyzed using <i>t</i> tests and linear regression by age, sex, BMI, diabetes, alcohol, smoking, disease duration, and biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) exposure. Patients (mean age 47.2, 48% female) had a mean Disease Activity Index for PsA of 22.7 (SD 12.9) and mean sonographic scores for synovitis and enthesitis of 35.6 (SD 22.9) and 30.1 (SD 22.1), respectively. Older patients showed significantly higher enthesitis, bone erosion, and NBF scores. Multivariable analysis revealed that age ≥ 60 years was linked to significantly higher inflammatory and structural enthesitis (adjusted β 6.37 and 14.6, respectively), bone erosion (β 2.53), and NBF (β 13.7) scores, and that b/tsDMARD exposure correlated with significantly higher synovitis (β 12.8) and tenosynovitis scores (β 5.95). Older age correlated with more severe inflammatory and structural lesions, reflecting either a more severe PsA phenotype or overlap with age-related changes. Higher synovitis and tenosynovitis scores in b/tsDMARD-exposed patients likely reflect disease severity rather than a direct effect of treatment. Incorporating contextual factors into sonographic assessments can improve personalized PsA management.