7. Sacroiliac Joint Involvement in PsA
Vladimirova et al., Abstract 05437
PsA is a heterogeneous condition that varies in the pattern of joint involvement, with the presence of axial disease an important determinant of signs, symptoms and clinical outcome. Distinguishing patients with a clinical diagnosis of psoriatic arthritis (clin-PsA) from those with axial spondyloarthritis with psoriasis (axSpA + PsO) thus depends on imaging studies of the spine, with magnetic resonance imaging (MRI) of major importance.
In this study of a multi-institution cohort of patients from Europe, Vladimirova et al. assessed radiographic findings in 373 patients with clin-PsA and 208 patients with axSpA + PsO. Overall, in this population, findings of inflammatory SpA were present in 21%, structural lesions in 28% and both types of lesions in 76%. In patients with MRI evidence of axPsA, MRI findings were bilateral in 76%, with bone marrow edema, erosions and fat lesions the most common features. MRI findings of axPsA were independently associated with male sex, HLA-B27 positivity, elevated C-reactive protein (CRP) values and a clinical history of inflammatory back disease. Current pack pain, however, was not discriminatory. On the other hand, peripheral arthritis showed a negative association with the findings in the spine. Clinical findings or radiographic definition (by routine X-rays) performed as well as MRI in categorizing patients.
While illuminating the diversity of MRI findings of axPsA, these observations pose important questions on the best approach to integrating MRI studies into routine care and using patient reports of symptoms in differentiating patterns of disease involvement. Another important issue is the reliability and accuracy of MRI readings by either rheumatologists or musculoskeletal radiologists in ordinary outpatient or hospital practices. Integrating advanced imaging (i.e., MRI) into routine care will, therefore, be an important challenge for the future.
8. Incidence & Risk of Arrhythmias in Patients with PsA
Almansouri et al., Abstract 05228
PsA, like other forms of inflammatory arthritis, is associated with an increased risk for cardiovascular disease (CVD), with an interplay between traditional risk factors (e.g., hypertension, diabetes) and systemic inflammation determining the overall risk. In this study, Almansouri and colleagues focused on arrhythmias as a manifestation of CVD and assessed the incidence and risk factors for tachy- and bradyarrhythmias in patients with PsA.
For this purpose, the researchers used a retrospective cohort analysis of patients followed from 1994 to 2024. Arrhythmias that were assessed include atrial tachyarrhythmias, bradyarrhythmias/pacemaker use and ventricular tachyarrthymias, including placement of implantable cardioverter-defibrillator devices. The cumulative incidence rate (CIR) of each arrhythmia was calculated, taking into account age, sex, PsA duration, cardiovascular risk factors and PsA therapies. Among the 1,670 patients studied, by age 70, the overall CIRs were 7.82%, 0.45% and 0.67% for atrial-, brady- and ventricular arrythmias. Importantly, remission/low disease activity was associated with a lower risk for atrial tachyarrhythmias, while a high score on a 3-item visual analog scale (3-VAS) was associated with a higher risk for atrial tachyarrhythmias. The risk was greater in older individuals.
