medwireNews: Patients with psoriasis who have structural entheseal lesions and cortical bone loss at entheseal segments are at increased risk for progressing to psoriatic arthritis (PsA), research suggests.
Presenting the findings at the EULAR 2020 E-Congress, David Simon (Friedrich-Alexander University Erlangen-Nürnberg, Germany) said: “Our findings substantiate the concept of mechano-inflammation in the pathogenesis of psoriatic disease.”
A total of 114 psoriasis patients, with a mean age of 45 years, were enrolled in the study and underwent high resolution computed tomography of the second and third metacarpophalangeal joints of the dominant hand to determine the presence of structural entheseal lesions.
In addition, bone mineral density (BMD) was measured at the entheseal and intra-articular segments,
The patients had a mean duration of psoriasis of 15.8 years and the average PASI score was about 7.0. Forty-one patients reported arthralgia of low overall intensity.
The follow-up period was 28.2 months on average, during which 24 patients developed PsA after a mean duration of 17 months. Of these, 70.8% had structural entheseal lesions at baseline, compared with just 26.7% of the 90 patients who did not develop PsA.
Simon also noted that the overall and cortical volumetric bone density in the entheseal segment at baseline was lower in patients who developed PsA, whereas there was no difference in intra-articular segments.
He reported an incidence of PsA of 21 per 100 patient–years in patients with structural entheseal lesions, compared with 4 per 100 patient–years in those who did not have lesions.
This yielded a 4.91-fold increased risk for PsA for patients with psoriasis and structural entheseal lesions, which remained largely unchanged, at 5.10, after adjustment for age, sex, BMI, duration of psoriasis, and the presence of structural entheseal lesions and arthralgia.
With regard to bone mineral density, a one standard deviation increase in entheseal density was associated with an approximate 30% reduced risk for progressing to PsA.
The researchers also looked at the effects of arthralgia on the risk for PsA, and Simon highlighted: “Patients without arthralgia and without structural entheseal lesions showed very low progression to PsA; subjects with both arthralgia and structural entheseal lesions had the highest progression rate.”
He acknowledged some limitations to the study, including the small number of patients who developed PsA and the potential for an overestimation of the risk for PsA attributed to structural entheseal lesions.
Nevertheless, Simon concluded that “based on these data, interventions with high efficacy in controlling entheseal inflammation appear as a valuable strategy in interfering with the onset of PsA in patients with psoriatic disease.”
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EULAR 2020 E-Congress; 3–6 June
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-eular.1524