Burden of ultrasonographic enthesitis in Psoriatic arthritis patients in DAS28 remission


A Mumtaz, A Saeed, R Mullan, D Kane


Department of Rheumatology, Adelaide and Meath Hospital, Tallaght, Dublin


Ultrasound (US) has been shown to be more sensitive and specific than clinical examination in the diagnosis of enthesitis in early Psoriasis and Psoriatic arthritis (PsA).(1)


To determine ultrasonographic burden of enthesitis in Psoriatic arthritis (PsA) patients in DAS 28 remission (DAS)


A prospective cohort of 42 PsA patients who satisfied the CASPAR criteria and were in DAS 28 remission was recruited.

For calculation of the GUESS score, Quadriceps Tendon Insertion (QTI), Patellar Ligament Origin (PLO), Patellar Ligament Insertion (PLI), the Achilles tendon Insertion (AI), and the plantar Aponeurosis (PA) were examined in both lower limbs of each patient.(2) Power Doppler(PD) US examination was undertaken by using a MyLab 70 XVG (Esaote SpA, Genoa, Italy) using broadband frequency transducer ranging from 6 to 18MHz and Doppler frequency ranging from 5.9 to 14.3MHz according to the target. Standardised PD settings were used with pulse repetition frequency (PRF) = 750 Hz, wall filter = 3 and Doppler frequency from 5.9 to 9.1MHz for entheses.


At the level of QTI, enthesophytes were present in 16 (38%), bursitis in 3 (7.14%) and PD was noted in7 (16.6%) patients. At the level of PLO, enthesophytes were noted in 5 (11.9%), bursitis and PD signal was noted in 3 patients (7.14%). At AI, enthesophytes were noted in 17, bursitis in 2 and PD signal was noted in 3 patients. At the level of PA, enthesophytes were noted in 7(16.6%), PD in 4 (9.1%), bursitis in 1 patient. At PA, one site had evidence of erosion and enthesophyte. The median GUESS score of the cohort was 5.Spearman rank correlation coefficient was used to demonstrate no correlation of the GUESS with either patient or physician global disease activity assessments nor with joint or skin assessment.


There is significant burden of clinically undetected psoriatic disease activity at the entheseal level in patients deemed to be in DAS remission. It is independent of the burden of the skin and joint disease.