In Those With Psoriasis, Treat for Arthritis?

Kevin Deane, MD, PhD


March 28, 2016

Subclinical Joint Inflammation in Patients With Psoriasis Without Concomitant Psoriatic Arthritis: A Cross-sectional and Longitudinal Analysis

Faustini F, Simon D, Oliveira I, et al
Ann Rheum Dis. 2016 Feb 25. [Epub ahead of print]

Article Summary

In this study, Faustini and colleagues performed clinical evaluations and imaging with contrasted MRI of the dominant hand in 55 patients with cutaneous psoriasis who were recruited from a dermatology clinic and who did not have inflammatory arthritis or enthesitis on physical examination at baseline. They followed these patients over time to evaluate them for the development of clinically apparent inflammatory arthritis.

At baseline, 26 of 55 (47%) participants had at least one inflammatory finding on MRI in their hands. The most common finding was synovitis (38%), followed by osteitis (11%) and flexor tendon tenosynovitis (4%) The synovitis was overall only mild to moderate according to the psoriatic arthritis (PsA) MRI scoring system and predominately located in the metacarpophalangeal joints and proximal interphalangeal joints (29% and 24%, respectively) and rarely in the distal interphalangeal joints (4%). In contrast, only 4 of 30 (13%) healthy control participants had inflammatory findings.

After a mean follow-up of 426 days, among 41 of the original 55 patients, 12 developed clinically apparent PsA per the Classification of Psoriatic Arthritis criteria. At baseline, those who developed arthritis had higher levels of pain as measured by a visual analog scale, tender joint count, and worse global health and function compared with participants who did not develop arthritis. Of note, no overall differences in MRI findings were seen at baseline between participants who developed PsA and those who did not. However, 56% of patients who had a combination of MRI findings of synovitis and symptoms related to arthralgia progressed to PsA within 1 year. In contrast, only 15% of those who had no MRI synovitis or arthralgia at baseline progressed to PsA.