Treating Early Subclinical Inflammation Could Prevent PsA



Early treatment was associated with regression of subclinical inflammation among patients with psoriasis without psoriatic arthritis (PsA), according to the findings of a recent study.

“Our findings support the concept that therapies that suppress subclinical enthesopathy may have the potential to prevent arthritis development, at least in a subset of cases, but this needs formal testing in longitudinal studies,” the researchers stated. 
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The open-label pilot study included 73 systemic therapy-naïve participants with moderate to severe psoriasis without symptoms of PsA and 23 healthy volunteers. All participants were screened using ultrasound for subclinical enthesitis at baseline. Twenty-three participants with inflammatory changes on ultrasound were treated with ustekinumab for 52 weeks.

At baseline and weeks 12, 24, and 52, the evolution of sonographic abnormalities was assessed using an extensive grey scale and power Doppler ultrasound protocol of the upper and lower limb entheses.

Overall, 49.3% of participants with psoriasis had at least 1 inflammatory entheseal abnormality on ultrasound. This confirms that subclinical enthesopathy among patients with psoriasis is not uncommon, the researchers wrote.

After treatment, the mean inflammation scores among participants with psoriasis were significantly reduced by 42.2% from baseline to week 24 and by 47.5% at week 52. However, entheseal structural abnormalities did not change significantly during treatment.

“IL-12/23 inhibition for psoriasis appears to suppress subclinical enthesopathy within 12 weeks of treatment, maintained to week 52,” the researchers concluded.

Savage L, Goodfield M, Horton L, et al. Regression of peripheral subclinical enthesopathy in therapy-naïve patients treated with ustekinumab for moderate-to-severe chronic plaque psoriasis [published online November 22, 2018]. Arthritis Rheumatol. doi:10.1002/art.40778