Regression of peripheral subclinical enthesopathy in therapy-naïve patients treated with Ustekinumab for moderate-to-severe chronic plaque psoriasis.

OBJECTIVE: This study investigated whether sonographically determined subclinical enthesopathy in patients with moderate-to-severe psoriasis regressed under therapy with ustekinumab, initiated for skin disease.

METHODS: Seventy-three systemic therapy-naïve patients with moderate-to-severe psoriasis and without symptoms of PsA, and 23 healthy volunteers, were screened using ultrasound for subclinical enthesitis. Subsequently, 23 psoriasis patients with "inflammatory changes" on ultrasound were treated with ustekinumab for 52 weeks. The evolution of sonographic abnormalities was assessed using an extensive grey scale (GS) and power Doppler (PD) ultrasound protocol of the upper and lower limb entheses at weeks 0, 12, 24 and 52. For each parameter, a GS or PD score >0 was taken as abnormal and a summative score (based on the GUESS) calculated.

RESULTS: 49.3% of screened patients with psoriasis had at least one inflammatory entheseal abnormality on ultrasound. Mean inflammation scores were higher in psoriasis patients compared with healthy volunteers: 9.9 (6.6) vs. 1.0 (1.4). With treatment, mean (95% C.I.) inflammation scores reduced significantly from week 0 by 42.2% to week 24 (-4.2 (-6.3,-2.1), p<0.001) and by 47.5% (-4.7 (-7.1,-2.3), p=0.001) to week 52. Entheseal structural abnormalities did not significantly change during treatment.

CONCLUSION: IL-12/23 inhibition for psoriasis appears to suppress subclinical enthesopathy within 12 weeks of treatment, maintained to week 52. Further longitudinal studies are needed to see whether therapy initiated for skin disease may prevent PsA development. This article is protected by copyright. All rights reserved.