EULAR rheumatology open · 2026
Does articular and entheseal structural damage drive pain and patient-driven reported outcomes in patients with difficult-to-treat psoriatic arthritis? Results from a cross-sectional study.
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Perrotta Fabio Massimo, Zabotti Alen, Fatica Mauro, Cabas Nicola, Guiotto Andrea, Franzolini Nicoletta, Giovannini Ivan, De Martino Maria, Di Nicola Cristina, Isola Miriam, Di Matteo Andrea, De Marco Gabriele, McGonagle Dennis, Quartuccio Luca, Lubrano Ennio
Аннотация
OBJECTIVES: This study aims to assess difficult-to-treat psoriatic arthritis (D2T-PsA) and determine whether articular and entheseal structural damage, assessed by ultrasound (US), may drive pain and patient-driven outcomes in D2T-PsA.
METHODS: A multicentre cross-sectional study was conducted on patients with PsA treated with biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Eligible participants were required to meet the following inclusion criteria: age ≥18 years; diagnosis of PsA fulfilling the classification criteria for Psoriatic Arthritis (CASPAR); classification as D2T-PsA, defined by failure of ≥2 classes of b/tsDMARDs (with different mechanisms of action) following the failure or contraindication of ≥1 conventional synthetic DMARD, and persistently active disease (Disease Activity Index for PsA >14). Sonographic evaluation was performed by using the US damage score (ultrasound in psoriatic arthritis [UPsA]) from the Ultrasound in PSoriatic arthritis TREAtMent (UPSTREAM) study. We used Spearman rho correlation coefficient to evaluate correlations between UPsA damage score and clinical features.
RESULTS: 53 patients with PsA were included in the analysis. The median (IQR) UPsA damage score of the 53 D2T patients was 3.79 (1.28-5.45). The UPsA damage score negatively correlated with tender joint count (rho -0.27, P = .04) but positively correlated with swollen joint count (rho +0.27, P = .05). The number of joint erosions and joint osteophytes/osteoproliferation correlated positively with physician global assessment of disease activity (PhGA) (rho +0.41, P = .002) (rho +0.27, P = .04) and correlated negatively with Δ patient global assessment of disease activity (PtGA)-PhGA (rho -0.30, P = .02) (rho -0.31, P = .02). No significant correlation was detected between pain and PtGA with UPsA damage score.
CONCLUSIONS: Preliminary results of our study in patients with D2T PsA showed that articular damage could be associated with PhGA and swollen joints, but not with pain, suggesting that patient-driven outcomes may potentially be related to inflammation or noninflammatory mechanisms rather than damage itself.
METHODS: A multicentre cross-sectional study was conducted on patients with PsA treated with biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Eligible participants were required to meet the following inclusion criteria: age ≥18 years; diagnosis of PsA fulfilling the classification criteria for Psoriatic Arthritis (CASPAR); classification as D2T-PsA, defined by failure of ≥2 classes of b/tsDMARDs (with different mechanisms of action) following the failure or contraindication of ≥1 conventional synthetic DMARD, and persistently active disease (Disease Activity Index for PsA >14). Sonographic evaluation was performed by using the US damage score (ultrasound in psoriatic arthritis [UPsA]) from the Ultrasound in PSoriatic arthritis TREAtMent (UPSTREAM) study. We used Spearman rho correlation coefficient to evaluate correlations between UPsA damage score and clinical features.
RESULTS: 53 patients with PsA were included in the analysis. The median (IQR) UPsA damage score of the 53 D2T patients was 3.79 (1.28-5.45). The UPsA damage score negatively correlated with tender joint count (rho -0.27, P = .04) but positively correlated with swollen joint count (rho +0.27, P = .05). The number of joint erosions and joint osteophytes/osteoproliferation correlated positively with physician global assessment of disease activity (PhGA) (rho +0.41, P = .002) (rho +0.27, P = .04) and correlated negatively with Δ patient global assessment of disease activity (PtGA)-PhGA (rho -0.30, P = .02) (rho -0.31, P = .02). No significant correlation was detected between pain and PtGA with UPsA damage score.
CONCLUSIONS: Preliminary results of our study in patients with D2T PsA showed that articular damage could be associated with PhGA and swollen joints, but not with pain, suggesting that patient-driven outcomes may potentially be related to inflammation or noninflammatory mechanisms rather than damage itself.