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Imaging and Early Detection in Psoriatic Arthritis
At EULAR 2025, there have been new developments in imaging in PsA.
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Hidradenitis suppurativa is newer to us in rheumatology, but it seems like inflamm arthritis is a problem - at least to a similar extent as in psoriasis.
Time for us to look for it & to see what therapies like IL-17 inhibitors do for this arthritis
#EULAR2025 POS1237 @RheumNow https://t.co/b5EQdDEAhq
David Liew drdavidliew ( View Tweet)
Low disease activity more difficult to achieve in vulnerable populations.
All rheumatic diseases - #RA #PsA #AS
initiating DMARDs takes longer in these population
#EULAR2025 @RheumNow https://t.co/voIivshKRt
Bella Mehta bella_mehta ( View Tweet)
In the APEX Phase 3b RCT (N=1020), guselkumab (IL-23p19 inhibitor) significantly reduced radiographic progression (ΔvdH-S 0.55 & 0.54 vs 1.35 PBO; p≤0.002) and improved ACR20 (67–68% vs 47%) at W24 in biologic-naïve PsA. Safety consistent with prior data. Abstract LB0010 https://t.co/mFDsBsCg6m
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In 4,121 SpA pts (mean age 45y; 61% male), composite scores w/ joint counts (DAPSA, DAS28, DAS44) best discriminated peripheral arthritis activity vs PGA & SJC alone. All scores had excellent construct validity; CRP weakest. Composite indices may optimize SpA assessment. https://t.co/oM97BEkkH5
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In clinical practice, not all US enthesitis findings are SpA-specific. Enthesophytes/calcifications common in healthy pts. Inflammatory lesions (PD signal, erosions) at Achilles, distal patella & greater trochanter better distinguish PsA/axSpA. Target key sites to improve US https://t.co/jO61QjKfQp
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In 581 PsA pts (EuroSpA), MRI showed axial SpA features in 31%: BME (69%), erosions (68%), fat lesions (58%). MRI-axPsA pts: younger (41y vs 46y), male (70%), HLA-B27+ (55%), ↑CRP (13 vs 7 mg/L). Radiographs identified sacroiliitis in 29%. MRI adds key detection. POS0297 https://t.co/nAw0BDAH22
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Using high-resolution peripheral quantitative computed tomography (HR-pQCT), patients with psoriatic arthritis (PsA) & psoriasis (PsO) show reduced cortical volumetric bone mineral density (vBMD) & thinner cortex vs controls. Bone mechanics impaired: reduced stiffness & failure https://t.co/ghH2cwOYJc
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In real-world PsA, IL-23 inhibitors (guselkumab/risankizumab) showed clinical response in axial/mixed PsA. Best response seen in pts meeting ASAS axial SpA criteria (RR 7.64) & baseline ASDAS-CRP >2.1. Supports role of patient stratification in axial PsA. Abstract#POS0113 https://t.co/qowZZmJOpM
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Are we missing axial/SIJ lesions in PsA or are we misdiagnosing AxSPA + PSO pts for PsA?
5 register studies including 580+ pts w/ PsA/AxSPA+PSO
1/3 PsA routine care patients had SIJ MRI = SPA
29% Rx SII r-mNY criteria+
of which 38% MRI lesions AxSPA
@RheumNow #EULAR2025 https://t.co/DJljlm7T9m
Aurelie Najm AurelieRheumo ( View Tweet)
Depression and anxiety in PsA is higher and has more consequences than in general population
Swedish and Danish clinical registers 23000+ PsA pts
HR 1.4 specialised psychiatric out/ inpatient care vs. general pop
HR for psychiatric in patient care numerically higher but ns.
No https://t.co/qduMcwGK0S
Aurelie Najm AurelieRheumo ( View Tweet)
Prediction of PsA in PSO pts: does it work?
First predictive model using mainly clinical data and labs extracted from primary care
Performs well in the cohort it was trained w/ but not in validation cohort.
Often an issue with prediction models!
Needs more granularity than https://t.co/5cVgqfd4fX
Aurelie Najm AurelieRheumo ( View Tweet)
PsA asso w/ higher risk of preterm births in women
Scandinavian registries
688 PsA pregnancies
8% preterm births vs. 4.5% general population OR 1.8
16.4% if bDMARD combination OR 4
3.1% if bDMARD monotherapy OR 0.7
bDMARDs combo probably a surrogate of high disease activity
Aurelie Najm AurelieRheumo ( View Tweet)
What's the difference between PIPsA & NIPsA?
(Persistent Inflammatory confirmed by IMAGING
vs. Non inflammatory PsA)
🔹️Cross-sectional study
🔹️517 pts under b/tsDMARDs
🔹️10.3% D2T
🔹️57% PIPsA / 43% NIPsA
👇 Distinct phenotypes 👇
OP0176
#EULAR2025
@rheumnow https://t.co/YGHpbeE6ws
Nelly ZIADE 🍀 Nellziade ( View Tweet)
What happens to the prevalence of D2T PsA if we use different parameters in its definition?
Data from 5 Nordic registries including 13,872 patients showed a variation from 37% (less stringent) to 0.6% (more stringent)!
OP0177
#EULAR2025
@rheumnow https://t.co/QbF15t3Zrz
Nelly ZIADE 🍀 Nellziade ( View Tweet)
🚨Diagnostic delays are real in axSpA:
-Can lead to more extra-msk manfieststions (EMMs) in PsA and axSpA.
-Increases disease burden and productivity losses.
-EMMs can present before articular sx
-Uveitis and IBD associated with longer dx delays.
-Diagnosis has improved since https://t.co/rWMwG7Ewwe
Links:
Adela Castro AdelaCastro222 ( View Tweet)
A machine learning (ML) model using electronic medical record (EMR) data from 396,000 Mayo Clinic primary care patients identified undiagnosed psoriatic arthritis (PsA) with area under the curve (AUC) 79.6%. Key predictors: psoriasis, joint pain, tenosynovitis, https://t.co/VsYevnJEjK
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
In 1314 PsA patients, cumulative methotrexate dose was not associated with liver fibrosis (OR 0.99). Instead, higher BMI (OR 1.03) & diabetes (OR 5.03) were key drivers. MASLD, not MTX, may underlie fibrosis risk in PsA. APRI >0.7 used for fibrosis detection. Abstract#POS0111 https://t.co/zsX7NUOT9m
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Tofacitinib vs biologics in PsA:
📍MI/stroke ✅ similar
📍Serious infection ✅ similar
📍Malignancy ✅ similar
📍VTE ❌ higher vs TNFi (aHR 0.26)
Large US claims study (n=48k)
Abstract POS0296 @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
📊 SIJ findings in PsA (n=581):
🧠 31% = MRI-confirmed axSpA
🦴 Only 29% met r-mNY criteria
MRI-axPsA group: younger, more male, HLA-B27+
Clinical + radiographic definitely underperform vs MRI
#POS0297 @RheumNow #EULAR2025
Jiha Lee JihaRheum ( View Tweet)
