The association of clinical parameters and ultrasound verified inflammation with patients' and physicians' global assessments in psoriatic arthritis.

Published on Oct 1, 2016in Seminars in Arthritis and Rheumatism5.072
· DOI :10.1016/J.SEMARTHRIT.2016.05.010
Angelika Lackner5
Estimated H-index: 5
(University of Graz),
Christina Duftner26
Estimated H-index: 26
+ 5 AuthorsChristian Dejaco29
Estimated H-index: 29
(University of Graz)
Abstract Objectives To study the association of clinical and/or ultrasound variables with patients' (PGA) and physicians' (EGA) global assessment of disease activity in psoriatic arthritis (PsA). The correlation of these parameters with the discordance between PGA and EGA, as well as with PGA/EGA changes over 6 months was also investigated. Methods Prospective study of 83 consecutive PsA patients with 2 visits scheduled 6 months apart. All patients underwent the following assessments: tender (TJC) and swollen joint count (SJC), PASI, dactylitis and Leeds enthesitis index. PGA, patients' level of pain (pain VAS), EGA, and HAQ were also recorded. Grey scale (GS) and power Doppler (PD) ultrasound were performed at 68 joints (evaluating synovia and tendons) and 14 entheses. Regression analyses were performed to assess the association of these variables with PGA and EGA. Two new variables "PGA minus EGA" and "PGAchange − EGAchange" were developed to explore the discrepancy between PGA and EGA and the consistency of PGA/EGA changes over time, respectively. Results The parameters explaining most of PGA and EGA variability were pain VAS (30.5%) and SJC (48.5%), respectively. The correlation between EGA and joint counts was stronger in patients with high vs. low levels of ultrasound verified inflammation. PGA minus EGA was mainly explained by pain and SJC. Pain was the most important predictor of PGA change whereas TJC and HAQ were more closely associated with EGA changes. "PGAchange-EGAchange" was linked to pain and SJC. Ultrasound scores were not linked with either of these variables. Conclusions Pain VAS and joint counts are the most important clinical parameters explaining patients' and physicians' perception of disease activity, whereas the correlation of active inflammation as verified by sonography with these factors is limited.
  • References (45)
  • Citations (7)
📖 Papers frequently viewed together
35 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Brigitte Michelsen (Hospital of Southern Norway)H-Index: 6
#2Andreas P. Diamantopoulos (Hospital of Southern Norway)H-Index: 19
Last. Glenn Haugeberg (NTNU: Norwegian University of Science and Technology)H-Index: 36
view all 6 authors...
Objective To investigate the association between clinical and ultrasonographic (US) evidence of inflammation in psoriatic arthritis (PsA), as well as to compare clinical and US remission criteria. Methods In this cross-sectional study 141 PsA outpatients were included. Minimal disease activity (MDA), 28-joint Disease Activity Score (DAS28), Disease Activity Index for PSoriatic Arthritis (DAPSA) and modified versions of Composite Psoriatic Disease Activity Index (CPDAI) and Psoriatic ArthritiS Di...
20 CitationsSource
#1Laure Gossec (University of Paris)H-Index: 57
#2Josef S Smolen (Medical University of Vienna)H-Index: 5
Last. D. van der Heijde (LEI: Leiden University)H-Index: 41
view all 34 authors...
Background Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations. Methods A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evid...
503 CitationsSource
#1Mats GeijerH-Index: 23
#2Ulla Lindqvist (Uppsala University)H-Index: 15
Last. Elke Theander (Lund University)H-Index: 34
view all 7 authors...
To describe early radiographic findings in patients from the Swedish psoriatic arthritis (SwePsA) registry, progression of destruction, correlations with clinical disease variables, and predictors of destruction.
24 CitationsSource
#1Peter Mandl (Medical University of Vienna)H-Index: 20
#2Victoria Navarro-Compán (LUMC: Leiden University Medical Center)H-Index: 16
Last. M ØstergaardH-Index: 17
view all 22 authors...
A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron em...
176 CitationsSource
#1Lihi Eder (Toronto Western Hospital)H-Index: 28
#2Arane Thavaneswaran (Toronto Western Hospital)H-Index: 20
Last. Dafna D. Gladman (Toronto Western Hospital)H-Index: 110
view all 5 authors...
Objective To assess the extent and determinants of discordance in scoring between patient global assessment (PtGA) and physician global assessment (PhGA) in patients with psoriatic arthritis (PsA). Methods A cross-sectional and longitudinal analysis of data was conducted in patients attending a large PsA clinic. The difference between PtGA and PhGA (each measured on a scale of 0–10, with 0 indicating best status and 10 indicating worst status) reflected the discrepancy between the PtGA and PhGA ...
38 CitationsSource
#1Anja Ficjan (University of Graz)H-Index: 7
#2Rusmir Husic (University of Graz)H-Index: 7
Last. Christian Dejaco (University of Graz)H-Index: 29
view all 9 authors...
Introduction This study was performed to develop ultrasound composite scores for the assessment of inflammatory and structural lesions in Psoriatic Arthritis (PsA).
28 CitationsSource
#1Sandra Falcão (NOVA: Universidade Nova de Lisboa)H-Index: 6
#1Sandra Falcão (NOVA: Universidade Nova de Lisboa)H-Index: 2
Last. Eugenio de MiguelH-Index: 20
view all 6 authors...
Background Spondyloarthritis (SpA) is a group of disorders that are characterized by inflammatory involvement of the enthesis and the adjacent bone. Enthesitis is regarded as the primary lesion and is observed in all SpA subtypes, and may sometimes be present for several years as an isolated clinical manifestation. Ultrasound is currently considered a powerful tool to identify entheseal affectation, capable of improving the diagnostic accuracy in SpA. Objectives To evaluate the construct validit...
13 CitationsSource
#1Moritoshi Furu (Kyoto University)H-Index: 22
#2Motomu Hashimoto (Kyoto University)H-Index: 15
Last. Mimori Tsuneyo (Kyoto University)
view all 11 authors...
35 CitationsSource
#1Rusmir Husic (University of Graz)H-Index: 7
#2Judith Gretler (University of Graz)H-Index: 7
Last. Christian Dejaco (University of Graz)H-Index: 29
view all 7 authors...
Objective To investigate the association between psoriatic arthritis (PsA)-specific clinical composite scores and ultrasound-verified pathology as well as comparison of clinical and ultrasound definitions of remission. Methods We performed a prospective study on 70 consecutive PsA patients. Clinical assessments included components of Disease Activity Index for Psoriatic Arthritis (DAPSA) and the Composite Psoriatic Disease Activity Index (CPDAI). Minimal disease activity (MDA) and the following ...
60 CitationsSource
#1M. L. Acosta Felquer (Hospital Italiano de Buenos Aires)H-Index: 1
#2L. Ferreyra Garrott (Hospital Italiano de Buenos Aires)H-Index: 1
Last. Enrique R. Soriano (Hospital Italiano de Buenos Aires)H-Index: 24
view all 9 authors...
Remission criteria and activity indices used in rheumatoid arthritis (RA) are often applied in psoriatic arthritis (PsA). Some new indices have been specifically developed for PsA. Our objective was to evaluate the performance of different remission criteria and activity indices in PsA. This is a cross-sectional study that includes consecutive patients with PsA. Information necessary to complete the following indices was captured: Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic Art...
23 CitationsSource
Cited By7
Objective To determine the prevalence of grey scale and power Doppler (PD) ultrasound (US) features of A1 pulley inflammation in a cohort of psoriatic arthritis (PsA) patients compared with rheumatoid arthritis (RA) patients. Methods Sixty patients (30 with PsA and 30 with RA) were consecutively enrolled. The main clinimetric indexes were recorded and US assessment of A1 pulleys of fingers 2nd to 5th bilaterally was carried out. The presence of A1 pulley inflammation, defined as PD signal within...
#2Eugenio de Miguel (Hospital Universitario La Paz)H-Index: 20
OBJECTIVE: To perform a systematic review of the literature to evaluate the use of the enthesis ultrasound Madrid Sonographic Entesis Index (MASEI) from its publication. METHODS: A systematic search of MEDLINE, EMBASE, and Cochrane Central Register databases was performed. The search strategy was constructed to identify publications containing terms related to enthesis and ultrasound. The only applied filter was studies conducted in humans. One reviewer systematically screened the search. A seco...
#1Philipp Bosch (University of Graz)
#2Rusmir Husic (University of Graz)H-Index: 7
Last. Christian Dejaco (University of Graz)H-Index: 29
view all 9 authors...
OBJECTIVE: To evaluate low disease activity (LDA) cut-offs in psoriatic arthritis (PsA) using ultrasound. METHODS: Eighty-three PsA patients underwent clinical and ultrasound examinations at two visits. LDA was assessed using the Disease Activity index for Psoriatic Arthritis (DAPSA ⩽ 14), the Psoriatic ArthritiS Disease Activity Score (PASDAS ⩽ 3.2), the Composite Psoriatic Disease Activity Index ⩽ 4, the DAS28-CRP ⩽ 2.8 and the minimal disease activity criteria. Ultrasound was performed at 68 ...
#1Ofir Elalouf (U of T: University of Toronto)H-Index: 4
#2Sibel Bakirci Ureyen (Toronto Western Hospital)H-Index: 1
Last. Lihi EderH-Index: 28
view all 7 authors...
Objective As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound working group, we performed a systematic review of the literature to assess the evidence and knowledge gaps in scoring instruments of enthesitis in psoriatic arthritis (PsA). Methods A systematic search of PubMed, EMBase, and Cochrane databases was performed. The search strategy was constructed to find original publications containing terms related to ultrasound, enthesitis, spondy...
7 CitationsSource
#1Silva PukšićH-Index: 1
Last. Hilde Berner HammerH-Index: 25
view all 6 authors...
Objectives Disease Activity index for PSoriatic Arthritis (DAPSA) (sum score 68/66 tender/swollen joint counts (68TJC/66SJC), patient’s global assessment, pain and C-reactive protein (CRP)) is recommended for clinical assessment of disease activity in patients with psoriatic arthritis (PsA). Ultrasound (US) (grey scale (GS) and power Doppler (PD)) detects inflammation in joints and extra-articular structures. The present objectives were to explore the longitudinal relationships between DAPSA, cl...
2 CitationsSource
#1Eleni Kampylafka (FAU: University of Erlangen-Nuremberg)H-Index: 3
#2Isabelle d’Oliveira (FAU: University of Erlangen-Nuremberg)H-Index: 2
Last. Axel J. Hueber (FAU: University of Erlangen-Nuremberg)H-Index: 30
view all 12 authors...
Although the effects of interleukin-17A (IL-17A) inhibition on the signs and symptoms of psoriatic arthritis (PsA) are well defined, little is known about its impact of local inflammatory and structural changes in the joints. The PSARTROS study was designed to elucidate the effects of IL-17A inhibition on inflammation and bone changes in joints affected by PsA. This was a prospective open-label study in 20 patients with active PsA receiving 24 weeks of treatment with the IL-17A inhibitor secukin...
15 CitationsSource
#1Philip J. Mease (UW: University of Washington)H-Index: 80
#2Laura C. Coates (University of Oxford)H-Index: 38
Abstract Objectives Psoriatic arthritis (PsA) is an autoimmune disease that can cause progressive structural damage of the joints and irreversible disability. The potentially achievable results of biologic therapy for PsA has led to the view that disease remission should be the goal of treatment. However, the heterogeneity of disease manifestations and need for validated outcome measures makes defining remission in PsA challenging. This article evaluates proposed criteria for defining remission ...
13 CitationsSource