ASYMPTOMATIC HELL ENTHESITIS IN PSORIASIS PATIENTS: AN ULTRASOUND STUDY

R. Ben Aissa, S. Boussaid, S. Rekik, S. Rahmouni, S. Jemmali, K. Zouaoui, H. Srairi Sahli, M. ElleuchRabta Hospital, Department of Rheumatology, Tunis, Tunisia  Background Enthesitis is a common clinical feature of psoriatic arthritis (PsA) especially in lower limb. Clinical screening for enthesitis in patients with psoriasis before developing PsA may be non-specific. Ultrasound has shown its value in the study of entheses. Objectives To asses heel entheses of asymptomatic psoriasis patients and healthy control using ultrasound. Methods We conducted a cross-sectional case-control study including psoriasis patients with no rheumatic symptoms and sex and age-matched healthy controls. We assessed the affected skin surface (SC) and the psoriasis severity score (PASI). Ultrasound evaluation of the calcaneal enthesis (CE) and the plantar fascia enthesis (PFE) was performed. Ultrasound abnormalities sought were: hypoechogenicity, enthesis thickening, bursitis, cortical erosion, calcification, enthesophyte, and presence of Doppler signal. Results A total of 76 patients (38 cases and 38 controls) were recruited with a mean age of 51.9±15 [19-76] years and male predominance (60%). On clinical examination, pressing pain was present at the CE and PFE in, respectively, 17.5% and 12.5% of psoriasis patients but with no significant difference comparing to controls (10% EC; 10% PFE respectively) (p=0.777; p=0.259 respectively). On ultrasound, 60% of psoriasis patients had at least one ultrasound abnormality at the CE versus 17.5% of controls (p<0.001). The most observed ultrasound abnormalities at the CE were: enthesophyte (n=17), enthesis thickening (n=15), erosions (n=11) and hypoechogenicity (n=5). The PFE was less affected on ultrasound, presenting abnormalities in 42.5% of psoriasis patients versus 12.5% of controls (p=0.410). Erosions (n=13) and enthesis thickening (n=12) were the most observed abnormalities. The presence of ultrasound abnormalities at the PFE in psoriasis patients was correlated with age (p=0.012) and disease duration (p=0.015). Psoriasis severity according to SC and PASI was not associated with the presence of ultrasound abnormalities at CE (p=0.860; p=0.417 respectively) and PFE (p=0.399, p=0.156 respectively). Conclusion Our study showed that psoriasis patients could have asymptomatic heel enthesitis with greater involvement of the CE. Psoriasis patients need regular monitoring and screening for early symptoms of PsA. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared. Keywords: Enthesitis, Ultrasound, Psoriatic arthritis DOI: 10.1136/annrheumdis-2023-eular.6268Citation: , volume 82, supplement 1, year 2023, page 744Session: Psoriatic arthritis - clinical aspects (other than treatment) (Poster View)