Imaging Detects Early Synovitis in Psoriasis Without PsA
Patients with psoriasis without any clinical signs of psoriatic arthritis (PsA) had more than a twofold greater risk for synovitis than healthy individuals, according to a systematic review and meta-analysis.
METHODOLOGY:
Researchers conducted a systematic review and meta-analysis of 12 cross-sectional and case-control studies through October 2024.
The analysis included 2606 participants: 1593 patients with psoriasis without musculoskeletal involvement (mean age, 46.4 years; 61.6% men), 327 patients with PsA (mean age, 50.2 years; 64.2% men), and 686 healthy individuals (mean age, 45.7 years; 48.8% men).
The mean duration of psoriasis was 14.8 years in patients with psoriasis and *9.8 years in those with PsA; the mean Psoriasis Area and Severity Index scores were 8.2 and 7.6, respectively.
The main outcome was detection of synovitis on imaging in patients with psoriasis vs those with PsA and control individuals.
TAKEAWAY:
Synovitis was present in significantly more patients with psoriasis compared with healthy individuals (risk ratio [RR], 2.55; P < .001).
Both ultrasonography (RR, 2.50; P = .03) and MRI (two studies; RR, 6.40; P = .003) detected synovitis, but detection rates were higher with MRI.
The risk for synovitis was not significantly different in patients with psoriasis than those with PsA (RR, 0.50; P = .19), although more patients with PsA had synovitis.
IN PRACTICE:
'Although imaging may serve as a valuable tool for identifying patients with psoriasis at higher risk of developing PsA, its role in routine clinical practice should be approached cautiously,' considering 'limitations, costs, and resource requirements,' the authors wrote. 'Future longitudinal studies,' they added, 'are needed to better characterize the transition from psoriasis to PsA, determine the predictive value of subclinical synovitis, and assess whether early intervention strategies could modify disease progression and reduce the risk of PsA development.'
SOURCE:
This study was led by Shanti Mehta, BSc, University of Toronto, Toronto, Ontario, Canada, and was published online on July 16 in JAMA Dermatology.
LIMITATIONS:
The studies were limited by nonstandardized protocols, variability in imaging and diagnostic criteria, and a relatively homogeneous patient population. The predominance of cross-sectional designs also limited assessment of the temporal link between synovitis and progression from psoriasis to PsA.
DISCLOSURES:
The authors did not report any funding information. One author reported receiving honoraria for speaking engagements from AbbVie, Janssen, Novartis, Sandoz, and Amgen.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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