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Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: A prospective cohort study.
Arthritis Care Res (Hoboken)
  • Pil Højgaard
  • Karen Ellegaard
  • Sabrina Mai Nielsen
  • Robin Christensen
  • Jørgen Guldberg-Møller
  • Christine Ballegaard
  • Lene Dreyer
  • Philip Mease, Swedish Medical Center, University of Washington, Seattle, United States.
  • Maarten de Wit
  • Lone Skov
  • Bente Glintborg
  • Henning Bliddal
  • Else Marie Bartels
  • Kirstine Amris
  • Lars Erik Kristensen
Document Type
Publication Date

OBJECTIVE: To study the prognostic value of widespread pain and of musculoskeletal ultrasound (US) examination for subsequent treatment outcomes in patients with psoriatic arthritis (PsA).

METHODS: An exploratory prospective cohort study enrolled PsA patients initiating biologic/conventional synthetic disease modifying anti-rheumatic drugs in routine care. Clinical-, US- and patient-reported measures were retrieved at baseline and after 4 months. Widespread non-arthritic pain (WP) was defined as Widespread Pain Index ≥4 with pain in ≥4/5 regions. PsA activity by US was defined as colour Doppler (CD) (yes/no) in selected entheses, joints or tendons. Main response criteria included American College of Rheumatology 20% (ACR20), Disease Activity in Psoriatic Arthritis 50% (DAPSA50), and Minimal Disease Activity (MDA). The primary analyses were age-and gender adjusted logistic regression.

RESULTS: WP was present in 24 (35%) of 69 included patients, and associated with worse patient-reported and composite baseline measures while US and other objective findings were similar to patients without WP. The odds of 4-months MDA were significantly greater for patients enrolled without WP (OR=18.43 [95% CI: 1.51-224.41], p=0.022), while WP did not impair other response measures. Patients with baseline CD activity (n=42 [61%]) had worse objective PsA burden but their chance of treatment response was comparable to those without CD.

CONCLUSIONS: More than one-third of PsA patients presented with widespread non-arthritic pain, which was associated with worse patient-reported scores and failure to achieve MDA following cs/bDMARD therapy. PsA activity by colour Doppler ultrasound had no influence on subsequent treatment response in this PsA cohort. This article is protected by copyright. All rights reserved.

Clinical Institute
Orthopedics & Sports Medicine
Citation Information
Pil Højgaard, Karen Ellegaard, Sabrina Mai Nielsen, Robin Christensen, et al.. "Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: A prospective cohort study." Arthritis Care Res (Hoboken) (2018)
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