Inflammation May Persist in PsA Patients Considered in Remission by Rheumatologist

Patients with psoriatic arthritis (PsA) considered to be in clinical remission by their provider may still perceive their disease activity as high. In some cases, ultrasound could be used to detect PsA inflammation via imaging.

In a new study presented at the American College of Rheumatology/Empowering Rheumatology Professionals Annual Meeting, its researchers analyzed whether persistent disease activity assessed by the patient considered to be in remission per their rheumatologist was correlated with ultrasound-measured inflammation. PsA patients who met the Classification Criteria for Psoriatic Arthritis and were considered to be in remission by their rheumatologist were included in the study. The study authors defined discordance as “a difference between patient’s and rheumatologist’s global assessment ≥30/100 on a Visual Analogic Scale [VAS].” Ultrasound imaging was conducted on 50 joints, 28 tendons, and 14 entheses.

Final analysis included 62 PsA patients, who were 40.3% female and had a mean (SD) age of 55 (14) years. Overall, 42% were in ultrasound remission and 71% in minimal ultrasound activity; 19.4% had at least one power Doppler (PD) synovitis, 88.7% had a B mode synovitis, 95.2% had a B mode abnormality on entheses, and 51.6% had at least one PD signal on entheses. Just under 40% of patients had a discordant disease activity assessment with their rheumatologist. Univariate analysis found no association between discordance and ultrasound remission (odds ratio [OR]=1.71; 95% CI, 0.61–4.83, P=0.224) or ultrasound minimal disease activity (OR=0.99; 95% CI, 0.32–3.05, P=0.602). Multivariate analysis identified an independent association between ultrasound remission and female sex (OR=3.94; 95% CI, 1.20–12.9, P=0.024) and younger age (OR=0.95; 95% CI, 0.91–0.99, P=0.027). There was a correlation between minimal ultrasound activity and history of enthesis lesion (OR=11.26; 95% CI, 1.34–94.93, P=0.026) and age (OR=0.95; 95% CI, 0.90–1.00, P=0.044).

The authors concluded that PsA patients considered by their rheumatologist to be in remission still presented inflammation via ultrasound, and patients with self-assessment of their disease discordant from their rheumatologist did not have a greater prevalence of ultrasound-evidenced residual inflammation.