Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis

Victoria Furer; Jonathan Wollman; David Levartovsky; Valerie Aloush; Ofir Elalouf; Hagit Sarbagil-Maman; Liran Mendel; Sara Borok; Daphna Paran; Ori Elkayam; Ari Polachek

doi:10.3899/jrheum.220547

Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis

J Rheumatol. 2023 Feb;50(2):197-203. doi: 10.3899/jrheum.220547. Epub 2022 Oct 15.

Affiliations

¹ V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
² V. Furer, MD, J. Wollman, MD, D. Levartovsky, MD, V. Aloush, MD, O. Elalouf, MD, H. Sarbagil-Maman, MD, L. Mendel, MSc, S. Borok, MD, D. Paran, MD, O. Elkayam, MD, and A. Polachek, MD, Department of Rheumatology, Tel Aviv Sourasky Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. arikpolachek@yahoo.com.

PMID: 36243411
DOI: 10.3899/jrheum.220547

Abstract

Objective: To investigate sex-based sonographic differences in patients with psoriatic arthritis (PsA).

Methods: The study population included consecutive prospectively recruited patients with PsA, as determined by the CASPAR (Classification for Psoriatic Arthritis) criteria, who underwent clinical and physical examinations, followed by a detailed ultrasound (US) evaluation (greyscale and Doppler). US evaluation included 52 joints, 40 tendons, and 14 points of entheses (Modified Madrid Sonographic Enthesis Index [MASEI] plus lateral epicondyles) performed by an experienced sonographer blinded to the clinical data. The US score was based on the summation of a semiquantitative score for synovitis, tenosynovitis, and enthesitis. The US enthesitis score was categorized into inflammatory lesions (ie, hypoechogenicity, thickening, bursitis, and Doppler) and structural lesions (ie, enthesophytes/calcifications and erosions).

Results: The study population of 158 patients included 70 males and 88 females. The males had higher rates of employment (P = 0.01), Psoriasis Area and Severity Index scores (P = 0.04), and mean swollen joint counts (P = 0.04). The total US score and its subcategory scores-the synovitis and tenosynovitis scores-were similar for both sexes, whereas the total enthesitis score and its subcategory score-the inflammatory enthesitis score-were significantly higher for the males compared to the females (P = 0.01 and P = 0.005, respectively). Hypoechogenicity, thickening, and enthesophytes were more prevalent in males compared to females (P < 0.05). Multivariate ordinal logistic regression models showed that male sex was associated with a higher US inflammatory enthesitis score compared to female sex (odds ratio 1.96, P = 0.02).

Conclusion: Sonographic enthesitis was more prevalent in males compared to females with PsA. These differences were not reflected by enthesitis disease activity scores derived from clinical assessment.

Keywords: enthesitis; gender; inflammation; psoriatic arthritis; spondyloarthritis; ultrasound.

MeSH terms

Arthritis, Psoriatic* / complications
Arthritis, Psoriatic* / diagnostic imaging
Enthesopathy* / complications
Enthesopathy* / diagnostic imaging
Female
Humans
Male
Psoriasis* / complications
Severity of Illness Index
Synovitis* / complications
Synovitis* / diagnostic imaging
Tenosynovitis* / complications
Tenosynovitis* / diagnostic imaging
Ultrasonography