Avoiding physical activity, biologics nonuse associated with less enthesitis in PsA

Patients with psoriatic arthritis (PsA) who avoid physical activity, are younger and are not using biologic agents have a lower risk of enthesis inflammation, suggests a study. Moreover, PsA patients and healthy volunteers aged 35–60 years show similar levels of inflammatory changes of the entheses, but the former have more structural damage.

This study included 84 patients with PsA and 25 healthy volunteers. Within PsA patients, older age (β, 0.07, 95 percent CI, 0–0.13) and current use of biologics (β, 1.56, 0.16–2.95) showed a small association with a higher inflammatory-modified MAdrid Sonographic Enthesitis Index (MASEI) score.

Those who reported avoiding activities had significantly lower inflammatory-modified MASEI scores (β, –1.71, –3.1 to –0.32) than those who did not. Furthermore, inflammatory scores of PsA patients aged 35–60 years (n=50) were similar to those of healthy volunteers, but the former had higher structural scores (median, 6 vs 2; p=0.01).

This cross-sectional study included consecutive patients with PsA, irrespective of enthesitis complaints and age. Data about complaints, physical activity and activity avoidance, medication, and clinical enthesitis were collected. Inflammatory and structural enthesis changes were scored using the modified MASEI.

The investigators used linear regression to assess the associations between ultrasound scores and clinical characteristics among all patients. They also compared ultrasound scores of health volunteers and PsA patients aged 35–60 years using Wilcoxon rank-sum tests.

“Enthesitis is a manifestation of PsA, but its symptoms are difficult to interpret clinically,” the investigators said.