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Original article
Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia
  1. Alen Zabotti1,
  2. Dennis G McGonagle2,
  3. Ivan Giovannini1,
  4. Enzo Errichetti3,
  5. Francesca Zuliani1,
  6. Anna Zanetti4,
  7. Ilaria Tinazzi5,
  8. Orazio De Lucia6,
  9. Alberto Batticciotto7,
  10. Luca Idolazzi8,
  11. Garifallia Sakellariou9,
  12. Sara Zandonella Callegher1,
  13. Stefania Sacco1,
  14. Luca Quartuccio1,
  15. Annamaria Iagnocco10 and
  16. Salvatore De Vita1
  1. 1Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
  2. 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
  3. 3Institute of Dermatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
  4. 4Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
  5. 5Unit of Rheumatology, IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
  6. 6Rheumatology and Orthopedic Department, ASST-Gaetano Pini/CTO Orthopedic and Traumatology Specialist Center, Milan, Italy
  7. 7Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi. “Ospedale di Circolo – Fondazione Macchi”, Varese, Italy
  8. 8Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
  9. 9Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  10. 10Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
  1. Correspondence to Dr Alen Zabotti; zabottialen{at}


Objective Non-specific musculoskeletal pain is common in subjects destined to develop psoriatic arthritis (PsA). We evaluated psoriatic patients with arthralgia (PsOAr) compared with psoriasis alone (PsO) and healthy controls (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the link between these imaging findings and subsequent PsA transition.

Methods A cross-sectional prevalence analysis of clinical and US abnormalities (including inflammatory and structural lesions) in PsOAr (n=61), PsO (n=57) and HCs (n=57) was performed, with subsequent prospective follow-up for PsA development.

Results Tenosynovitis was the only significant sonographic feature that differed between PsOAr and PsO (29.5% vs 5.3%, p<0.001), although synovitis and enthesitis were numerically more frequent in PsOAr. Five patients in PsOAr and one in PsO group developed PsA, with an incidence rate of 109.2/1000 person-years in PsOAr vs 13.4/1000 person-years in PsO (p=0.03). Visual Analogue Scale pain, Health Assessment Questionnaire, joint tenderness and US active enthesitis were baseline variables associated with PsA development.

Conclusion Tenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. These findings are relevant for enriching for subjects at risk of imminent PsA development.

  • psoriasis
  • psoriatic arthritis
  • psoriatic arthralgia
  • pain
  • ultrasound
  • preclinical phase

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  • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: all authors. Drafting the work or revising it critically for important intellectual content: all authors. Final approval of the version published: all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted according to a protocol approved by the Local Ethical Committees.

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

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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