Advantages of combined Derma-Rheumatological evaluation in Early Psoriatic Arthritis

Background: Psoriatic Arthritis (PsA) is a challenging diagnosis both for the absence of specific biomarkers and for its clinical heterogeneity, especially in its initial phases. Early onset of PsA is mostly characterized by mono-oligoarthritis, enthesitis, dactylitis, onychopathy, modest cutaneous involvement. At least 50% of early-PsA patients initially come at dermatologist’s attention because they carry only few musculoskeletal symptoms such as enthesitis and dactylitis. Rheumatological evaluation and ultrasound (US) demonstration of articular and entheseal inflammation allows to augment the probability of an early diagnosis in a short period of time. Objectives: We described patients referred to our derma-rheumatological clinic. We focused our attention on the main affected domain and on the advantages of a combined evaluation in terms of diagnosis, access to advanced therapies and short-term outcome. Methods: All patients referred to our derma-rheumatological clinic by dermatologists from July 2017 to July 2019 for suspected PsA were considered in the present study. 55% of them were studied with US, according to clinical necessity. All the suspected domains were studied using both B-mode and Power Doppler. Results: 81 patients, sent to our attention for suspected PsA, were included. In 18 (37%) of them diagnosis was confirmed (Caspar criteria were satisfied). In these patients oligoarthritis (80%), enthesitis (40%), dactylitis (23%), sometimes in combination, were the most frequent presentations. In 25% of cases enthesitis was the only clinical feature. Articular disease activity was low to moderate in most of patients (DAPSA 14,83 ± 10,08). Disease duration at the diagnosis was 12 months in 90% of cases and the time occurring between symptoms and the first advanced therapy was 18 months in 50% of cases. US study allowed to redefine disease status in 30% of cases. Arthritis and enthesitis were the main domains where US evaluation gave more diagnostic value. Conclusion: literature reports a mean time to diagnosis and to start advanced pharmacological therapy respectively of 1,5 and 5 years. In our report, time to start advanced therapy was much lower than expected, falling in the so-called window of opportunity. US study importantly contributed to reach this target, allowing us to identify as soon as possible sub-clinical and pauci-symptomatic forms (low disease activity, prevailing entheseal domain), which could otherwise be misdiagnosed or have an important diagnostic delay. The attention of dermatologist and integrated evaluation allowed us to optimize our diagnostic-therapeutic work-up in patients affected by early PsA, allowing them to receive sooner advanced therapies, according to recent EULAR and GRAPPA recommendations. REFERENCES: [1]Lubrano E, et al. Residual Disease Activity and Associated Factors in Psoriatic Arthritis. J Rheumatol. 2020 Oct 1;47(10):1490-1495. Clinical Rheumatology (2020) [2]GRAPPA Treatment Recommendations: An Update From the 2020 GRAPPA Annual Meeting LC Coates et al. The Journal of Rheumatology Feb 2021, jrheum.201681. Disclosure of Interests: None declared Citation: , volume 81, supplement 1, year 2022, page 1591Session: Psoriatic arthritis - clinical aspects (other than treatment) (Publication Only)