Rheumatology, Women's College Hospital, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
RMD Open. 2024 Oct 30;10(4):e003995. doi: 10.1136/rmdopen-2023-003995.
To investigate the association between musculoskeletal sonographic features and clinical features, as well as treatment outcomes, in patients with active psoriatic arthritis (PsA).
A prospective cohort study was conducted involving patients with active PsA. Disease activity was assessed clinically at baseline and 3-6 months after initiating therapy, with a Disease Activity Index for PsA (DAPSA) score calculated. A baseline ultrasound examination of 64 joints, 28 tendons and 16 entheses evaluated the following lesions: synovitis, peritenonitis, enthesitis, tenosynovitis, new bone formation and erosions. Total scores for each lesion and total inflammatory and structural scores were calculated. The association between baseline sonographic scores and treatment outcomes was assessed using Cox proportional hazards models (for drug persistence) and generalised estimating equation models for DAPSA change.
A total of 135 treatment periods (107 patients) were analysed. Multivariable analysis showed that a greater reduction in DAPSA score at follow-up was associated with higher baseline synovitis (β -3.89), peritenonitis (β -3.93) and enthesitis structural scores (β -2.91). Additionally, the total inflammatory score independently predicted DAPSA change (β -5.23) regardless of the total structural damage score. Drug persistence was analysed in 105 treatment periods, revealing that a higher sonographic erosion score was associated with earlier drug discontinuation (adjusted HR 1.28, 95% CI 1.03 to 1.61).
The study results provide preliminary evidence supporting the utility of musculoskeletal ultrasound in predicting treatment response and drug persistence in PsA.
探讨活动性银屑病关节炎（PsA）患者的肌肉骨骼超声表现与临床特征及治疗结局的相关性。
开展了一项前瞻性队列研究，纳入活动性 PsA 患者。在基线和治疗开始后 3-6 个月时进行临床疾病活动评估，计算出银屑病关节炎疾病活动指数（DAPSA）评分。基线时对 64 个关节、28 条肌腱和 16 个附着点进行超声检查，评估以下病变：滑膜炎、肌腱周围炎、附着点炎、腱鞘炎、新骨形成和侵蚀。计算出每个病变和总炎症及结构评分。采用 Cox 比例风险模型（用于药物持续时间）和广义估计方程模型评估基线超声评分与治疗结局的相关性。
共分析了 135 个治疗期（107 例患者）。多变量分析显示，随访时 DAPSA 评分降低幅度更大与基线时滑膜炎（β -3.89）、肌腱周围炎（β -3.93）和附着点炎结构评分（β -2.91）更高相关。此外，总炎症评分独立预测了 DAPSA 变化（β -5.23），而与总结构损伤评分无关。对 105 个治疗期进行了药物持续时间分析，结果显示超声侵蚀评分越高，药物停药越早（调整后的 HR 1.28，95%CI 1.03 至 1.61）。
研究结果初步证实了肌肉骨骼超声在预测 PsA 治疗反应和药物持续时间方面的作用。
