The management of enthesitis in clinical practice

Purpose of review Enthesitis is a hallmark feature of the spondyloarthropathies (SpA). This review provides an overview of recent insights on diagnosis and management of enthesitis. Recent findings Recent studies support the use of imaging for diagnosis because of its higher sensitivity and specificity compared with clinical examination. Several new MRI and ultrasound scoring systems have been developed for enthesitis, which may facilitate the use of imaging in research. Enthesitis has been evaluated as a primary study outcome mainly in psoriatic arthritis (PsA); however, the use of different indices and definitions of improvement limits comparison across studies. There is very limited information about the efficacy of synthetic disease modifying antirheumatic drugs (DMARDs) for the treatment of enthesitis. In contrast, targeted and biologic DMARDs have all shown efficacy in treating enthesitis compared with placebo. There have been only a few head-to-head trials that compared two different cytokine inhibitors for the treatment of enthesitis. Preliminary data suggest that targeting IL-17 or IL12/23 may be more efficacious for controlling enthesitis than TNF inhibition. Summary Emerging data suggest interleukin-17 and 12/23 inhibitors may be the first choice in PsA patients with enthesitis. Further head-to-head studies are needed before making definitive recommendations.
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Related Links:

Authors: Ortolan A, Ramonda R, Lorenzin M, Pesavento R, Spinazzè A, Felicetti M, Nardin C, Rattazzi M, Doria A, Puato M Abstract OBJECTIVES: Our aim was to evaluate subclinical atherosclerosis progression during 5 years of anti-tumour necrosis factor (TNF)-α treatment in psoriatic arthritis (PsA) patients. METHODS: Thirty-two consecutive PsA patients starting TNF-α inhibitors were enrolled and evaluated at baseline (T0), 2 years (FU1) and 5 years (FU2) of treatment. Arterial structural properties were evaluated by B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
Herrero-Beaumont G, Naredo E Abstract BACKGROUND:  Digital subcutaneous tissue (SCT) changes are involved in dactylitis, a hallmark feature of psoriatic arthritis (PsA). There are no studies on the ultrasound (US) characteristics of the digital SCT in the general population. OBJECTIVES:  To investigate the variability in US-measured thickness (TH) and color Doppler (CD)-detected blood flow of the SCT of the volar aspects of the fingers in a non-psoriatic population and to investigate the impact of the scanning method and demographics and clinical features on these measurements. METHODS:  ...
Source: Ultraschall in der Medizin - Category: Radiology Authors: Tags: Ultraschall Med Source Type: research
CONCLUSION: The results of this study suggest that the intensity, rather than the type, duration or distribution of musculoskeletal symptoms is associated with PsA among patients with psoriasis. PMID: 32414953 [PubMed - as supplied by publisher]
Source: Journal of Rheumatology - Category: Rheumatology Tags: J Rheumatol Source Type: research
AbstractMany rheumatic diseases may present with an inflammatory joint syndrome, affecting the small joints of the hands, of which rheumatoid (RA) and psoriatic arthritis (PsA) being one of the most common. The aim of this systematic review was to focus on the literature evidence regarding the added value of ultrasound (US) of the hand in the differential diagnosis between RA and PsA. Pubmed and Scopus were searched to identify original manuscripts, published in the last 20  years utilising ultrasonography to reveal specific hand US patterns. Studies were eligible if they: (1) included adults (over 18 years) with...
Source: Rheumatology International - Category: Rheumatology Source Type: research
AbstractAimTo analyze the prevalence of subclinical atherosclerosis (SA), as well as the factors associated with it, in psoriatic arthritis (PsA).MethodsThis cross-sectional observational study included 140 consecutive patients with PsA. Systematic COronary Risk Evaluation (SCORE) risk charts and carotid ultrasound (CU) were used to estimate cardiovascular risk (CVR). The presence of plaque and/or a carotid intima-media thickness (cIMT)>  0.9 mm defined SA. Disease features associated with SA were analyzed.ResultsThe prevalence of SA in this study was 25%. According to the SCORE charts, 42.8%, 35.7%, and 21....
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
Authors: Yamada Y, Inui K, Okano T, Mandai K, Mamoto K, Koike T, Takeda S, Yamashita E, Yoshida Y, Tateishi C, Tsuruta D, Nakamura H Abstract OBJECTIVES: Enthesitis is a major musculoskeletal manifestation of psoriatic arthritis (PsA). It is conventionally assessed clinically, by the presence of tenderness, despite its low reliability. However, ultrasound (US) provides a sensitive and feasible method for evaluating enthesitis. We investigated enthesitis as assessed clinically and by US in patients with PsA. METHODS: Forty-seven patients with PsA underwent US examination of the bilateral humeral medial epicondyl...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
Condition:   Psoriatic Arthritis Interventions:   Other: General evaluation;   Other: Dermatological evaluation;   Other: Rheumatological evaluation;   Other: para clinical data;   Other: Patient reported outcomes (PROs) Sponsor:   Assistance Publique - Hôpitaux de Paris Not yet recruiting
Source: - Category: Research Source Type: clinical trials
Authors: Fiorenza A, Bonitta G, Gerratana E, Marino F, Sarzi-Puttini P, Salaffi F, Atzeni F Abstract OBJECTIVES: The primary aim of this study was to compare the prevalence of clinical and particularly ultrasonographic signs of enthesitis in patients with psoriatic arthritis (PsA), fibromyalgia (FM), or both. The secondary aim was to assess the impact of FM on disease activity and clinimetric scores. METHODS: This single-centre, observational cross-sectional study involved 101 consenting patients: 39 with PsA (CASPAR criteria), 23 with FM (2016 criteria), and 39 with both. Standard PsA and FM clinical, laborato...
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
Publication date: Available online 29 February 2020Source: The Egyptian RheumatologistAuthor(s): Sally El-Leithy, Nahed Sherif, Nadia H. El-Arousy, Rana El-Hilaly, Marwa M. Shakweer
Source: The Egyptian Rheumatologist - Category: Rheumatology Source Type: research
CONCLUSION: PsA patients are more frequently reclassified into the very-high SCORE risk category following carotid ultrasound assessment than controls. This was independently explained by the disease activity. PMID: 31732555 [PubMed - as supplied by publisher]
Source: J Rheumatol - Category: Rheumatology Authors: Tags: J Rheumatol Source Type: research
More News: Arthritis | Psoriatic Arthritis | Rheumatology | Study | Ultrasound