Clinical and ultrasound features of a cohort of psoriasis patients without musculoskeletal symptoms: a prospective and multicenter study

Objectives To evaluate clinical and ultrasound (US) features related to psoriatic arthritis (PsA) development in psoriasis (PsO), patients without musculoskeletal (MSK) symptoms and no systemic treatment. Methods Prospective study including PsO patients followed by dermatologists. Clinical, and US data were collected at baseline and during follow-up by rheumatologists. Results Seventy-eight patients with PsO were included. Mean disease duration was 15.1 years (SD ± 13.4); most had mild PsO (82%), onychopathy was present in 36 (39.7%) and overweight/obesity in 38 patients (48.7%). In the US evaluation, 9 patients (11.5%) had Power Doppler grade 1 at joints, 56.4% had calcifications and 30.4% bursitis at enthesis. Sixty patients completed the study. After a median of 76.60 months (IQR 39.34-85.25), 34 patients (56.6%) developed MSK symptoms. They had higher BMI (p = 0.013), abdominal circumference (p = 0.022), scored higher for pain (p = 0.047) and fatigue (p = 0.011). Their baseline US showed a higher total US score (p = 0.037). Five patients (8.3%) developed MSK inflammatory symptoms, and 4 met CASPAR criteria (5,5%). The mean time from baseline to PsA diagnosis was 20.20 months (SD ± 12.02). US bursitis was present in 80% of patients developing inflammatory symptoms (p = 0.049). Conclusions In a cohort of patients with mild PsO, systemic therapy-naïve and no MSK symptoms, incidence of PsA was 1% per year. US bursitis at enthesis was related to the development of symptoms suggestive of PsA. Patients who developed MSK symptoms had higher BMI, fatigue and pain VAS scores at baseline and could constitute a subgroup with higher risk for transition to PsA.