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Extended report
Ultrasonographic evaluation in psoriatic arthritis is of major importance in evaluating disease activity
  1. Brigitte Michelsen1,
  2. Andreas P Diamantopoulos1,2,
  3. Hilde B Hammer3,
  4. Dag M Soldal1,
  5. Arthur Kavanaugh4,
  6. Glenn Haugeberg5,6
  1. 1Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
  2. 2Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway
  3. 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Division of Rheumatology, Allergy, Immunology, University of California San Diego, San Diego, California, USA
  5. 5Department of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
  1. Correspondence to Dr Brigitte Michelsen, Department of Rheumatology, Hospital of Southern Norway Trust, Service box 416, Kristiansand 4604, Norway; brigitte_michelsen{at}


Objective To investigate the association between clinical and ultrasonographic (US) evidence of inflammation in psoriatic arthritis (PsA), as well as to compare clinical and US remission criteria.

Methods In this cross-sectional study 141 PsA outpatients were included. Minimal disease activity (MDA), 28-joint Disease Activity Score (DAS28), Disease Activity Index for PSoriatic Arthritis (DAPSA) and modified versions of Composite Psoriatic Disease Activity Index (CPDAI) and Psoriatic ArthritiS Disease Activity Score (PASDAS) were assessed. Remission criteria were explored. US evaluation was performed on 34 joints, in addition to joints being tender/swollen by 66/68 joint count, 30 tendons, 10 entheses and additionally entheses found to be tender by clinical examination of 19 other entheses. Power Doppler (PD) and grey scale global scores on joints, entheses and tendons were assessed. US remission was defined as no PD activity in joints, entheses and tendons.

Results DAPSA and DAS28, but not CPDAI and PASDAS, were associated with PD activity. MDA was fulfilled in 22.7% and the clinical remission criteria in 5.7%–9.9% of the patients. US remission was found in 49.6% of the patients. The prevalence of PD activity at joints, entheses and tendons was similar for patients fulfilling versus not fulfilling MDA/clinical remission criteria. MDA (OR 2.3, p=0.048), DAPSA ≤3.3 (OR 4.2, p=0.025) and Boolean's (OR=7.8, p=0.033) definitions of remission were found to predict US remission.

Conclusions We found major discrepancies between US and clinical findings. DAPSA and DAS28 reflected US findings better than CPDAI and PASDAS. MDA, DAPSA and Boolean's remission criteria predicted US remission.

  • Psoriatic Arthritis
  • Ultrasonography
  • Disease Activity

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  • Handling editor Gerd R Burmester

  • Contributors GH, DMS, APD, HBH, AK and BM were responsible for study design. BM, APD, DMS and GH were responsible for data acquisition. BM analysed the data and wrote the manuscript. All authors critically revised the manuscript and approved the final version.

  • Funding Unrestricted grant from Pfizer ID WS1948310 (GH). Clinical research fellowship from the Hospital of Southern Norway Trust (BM).

  • Competing interests APD: advisory board for Novartis and Pfizer, speaker fees from Abbvie; HBH: honorary fee from Abbvie, Pfizer, UCB, Roche; GH: founder and shareholder in DiaGraphIT. Unrestricted grant from Pfizer Norway.

  • Ethics approval Norwegian Regional Committees for Medical and Health Research Ethics Midt-Norge.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All important data are within the text.

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