'Double target' ultrasound monitoring of biologic therapy in psoriatic arthritis

Clin Exp Rheumatol. 2024 Mar;42(3):626-632. doi: 10.55563/clinexprheumatol/mdjddz. Epub 2024 Jan 8.

Abstract

Objectives: We aimed to 1) evaluate by power Doppler (PD) ultrasound (US) the response to therapy of the most inflamed joint and enthesis (target sites) in psoriatic arthritis (PsA) patients starting a biologic disease-modifying anti-rheumatic drug (bDMARD); and 2) to investigate the correlation between the US response and clinical data.

Methods: Consecutive PsA patients with US synovitis and US 'active' enthesitis, starting a bDMARD, were included. The joint with the highest OMERACT-EULAR-US composite score and the enthesis with the highest PD grade (targets) were identified at baseline. The US examination and clinical assessment were performed at 0, 3 and 6 months. The response of OMERACT-EULAR-US synovitis composite score was defined as reaching a grade = 0 at follow-up examination; synovial and entheseal PD responses were defined as a PD=0 and/or a reduction of ≥2 PD grades at follow-up examination.

Results: Thirty patients were included. Synovitis composite score, synovial PD and entheseal PD showed significant responses at 3 and 6 months compared to baseline (p<0.01). Synovial PD responses were higher than entheseal PD responses at 3 months (71.4% vs 40.0%, p=0.01) and 6 months (77.8% vs. 46.7%, p=0.02). US synovitis responses were correlated with DAPSA (p<0.01) and MDA responses (p=0.01 for composite score, p=0.02 for PD).

Conclusions: US was found sensitive for monitoring treatment response in PsA patients starting a biologic drug. Entheseal PD was less responsive than synovial PD, suggesting that enthesitis may represent a 'difficult-to-treat' domain in PsA.

MeSH terms

  • Antirheumatic Agents* / therapeutic use
  • Arthritis, Psoriatic* / diagnostic imaging
  • Arthritis, Psoriatic* / drug therapy
  • Biological Therapy
  • Enthesopathy* / diagnostic imaging
  • Enthesopathy* / drug therapy
  • Enthesopathy* / etiology
  • Humans
  • Synovitis* / diagnostic imaging
  • Synovitis* / drug therapy
  • Ultrasonography
  • Ultrasonography, Doppler

Substances

  • Antirheumatic Agents