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Role of ultrasound for assessment of psoriatic arthritis patients with fibromyalgia
  1. Ari Polachek1,2,
  2. Victoria Furer1,2,
  3. Mirna Zureik1,2,
  4. Sharon Nevo1,2,
  5. Liran Mendel1,2,
  6. David Levartovsky1,2,
  7. Jonathan Wollman1,2,
  8. Valerie Aloush1,2,
  9. Reut Tzemach1,2,
  10. Ofir Elalouf1,2,
  11. Marina Anouk1,2,
  12. Mark Berman1,2,
  13. Ilana Kaufman1,2,
  14. Or Carmi1,2,
  15. Yael Lahat1,2,
  16. Tali Eviatar1,2,
  17. Hagit Padova1,2,
  18. Hagit Sarbagil-Maman1,2,
  19. Sara Borok1,2,
  20. Adi Broyde1,2,
  21. Lihi Eder3,4,
  22. Daphna Paran1,2,
  23. Ori Elkayam1,2
  1. 1 Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  2. 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3 Women's College Hospital, Toronto, Ontario, Canada
  4. 4 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Ari Polachek, Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; arikpolachek{at}


Objective To investigate whether ultrasonography (US), as an objective imaging modality, can optimise the evaluation of disease activity in psoriatic arthritis (PsA) patients with concomitant fibromyalgia syndrome (FMS).

Methods The study population included 156 consecutive PsA patients who were recruited prospectively and fulfilled the ClASsification criteria for Psoriatic ARthritis criteria. The patients underwent complete clinical evaluation including assessment of fulfilment of the 2016 fibromyalgia classification criteria. All of the patients underwent US evaluation including 52 joints, 40 tendons and 14 entheses. The US score was based on the summation of a semiquantitative score (including synovitis, tenosynovitis and enthesitis). Scoring was performed by a sonographer blinded to the clinical data. Spearman’s correlation coefficient and multivariate linear regression models were used to examine the association of FMS with clinical and the US scores.

Results Forty-two patients (26.9%) with coexisting PsA and FMS were compared with 114 (73.1%) PsA patients without FMS. Patients with PsA and FMS had significantly increased scores for clinical composite indices, including non-Minimal Disease Activity, Composite Psoriatic Disease Activity Index (CPDAI), Disease Activity for Psoriatic Arthritis (DAPSA) and Psoriatic Arthritis Disease Activity Score (PASDAS) (p<0.001). In contrast, the total US score and its subcategories were similar for those with and without FMS. The total US score significantly correlated with CPDAI, DAPSA and PASDAS (p<0.001) in the PsA without FMS but not in the PsA with FMS group. FMS was significantly associated with higher clinical scores (p<0.001) but not with the US score (multivariable linear regression models).

Conclusions US has significantly greater value than composite clinical scores in the assessment of disease activity in PsA patients with FMS.

  • arthritis
  • psoriatic
  • inflammation
  • ultrasonography
  • fibromyalgia

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Handling editor Josef S Smolen

  • Contributors All authors contributed to conception and design of the study, acquisition and/or interpretation of data, drafting the article or revising it critically for important intellectual content and approved the final version of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.