Introduction Enthesitis is a hallmark of psoriatic disease, but its clinical assessment is problematic in terms of diagnostic sensitivity and overlap with other comorbid conditions. Ultrasound is a useful tool that can give a more detailed assessment of enthesitis. Research demonstrates that those with persistent ultrasound entheseal disease are at risk of progressive articular damage. With limited data to guide choice between biologic therapy for psoriatic arthritis (PsA) patients, we wanted to assess the response of ultrasound-confirmed enthesitis to different forms of biologic therapies and study its utility in making more informed decisions. Methods This was an open label observational study including patients aged ⩾18 years, who fulfil the classification criteria for PSA (CASPAR) and were due to commence on their first biologic therapy. The primary outcome was the change in MAdrid Sonographic Enthesitis Index (MASEI) score at 16 weeks of treatment. The MASEI score was also modified to assess the active elementary lesions (ActiveMASEI). Results In all, 80 PsA patients were enrolled with 75 patients completing the study [secukinumab n = 23 and tumour necrosis factor inhibitor (TNFi) n = 52]. The mean reduction in MASEI score after 16 weeks of treatment was 3.42 with TNFi versus 1.74 with secukinumab (p = 0.097). There was a significant difference in the change in the MASEIActive score for TNFi versus secukinumab (4.37 versus 2.26; p = 0.030) and this difference was more pronounced when only power Doppler signal within 2 mm of the enthesis insertion was included (4.37 versus 2.00; p = 0.007). Clinical outcomes were similar for both classes of biologic apart from a significant reduction in regards to the Dermatology Life Quality Index and Psoriasis Area and Severity Index score with secukinumab versus TNFi. Conclusions We have for the first time compared the effect of ultrasound-confirmed enthesitis between different forms of biologic therapies for PsA. We have seen an overall improvement in entheseal scores for both classes of medications and demonstrated a larger reduction in active entheseal disease for TNFi versus secukinumab that merits further exploration.

中文翻译：

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TNF-α 抑制与苏金单抗对银屑病关节炎活动性超声确认附着点炎的影响。

简介 附着点炎是银屑病的一个标志，但其临床评估在诊断敏感性以及与其他合并症的重叠方面存在问题。超声波是一种有用的工具，可以对附着点炎进行更详细的评估。研究表明，患有持续性超声附着点疾病的人面临进行性关节损伤的风险。由于指导银屑病关节炎 (PsA) 患者生物治疗选择的数据有限，我们希望评估超声确认的附着点炎对不同形式的生物治疗的反应，并研究其在做出更明智决策方面的效用。方法 这是一项开放标签观察性研究，纳入年龄≥18 岁、符合 PSA (CASPAR) 分类标准且即将开始首次生物治疗的患者。主要结果是治疗 16 周时 MAdrid 超声附着点炎指数 (MASEI) 评分的变化。MASEI 评分也进行了修改，以评估活动性基本病变 (ActiveMASEI)。结果 总共有 80 名 PsA 患者入组，其中 75 名患者完成了研究 [苏金单抗 n = 23 和肿瘤坏死因子抑制剂 (TNFi) n = 52]。治疗 16 周后，TNFi 组的 MASEI 评分平均降低 3.42，而苏金单抗组则为 1.74（p = 0.097）。TNFi 与苏金单抗的 MASEIActive 评分变化存在显着差异（4.37 与 2.26；p = 0.030），并且当仅包括附着点插入 2 mm 内的功率多普勒信号时，这种差异更为明显（4.37 与 2.00；p = 0.030）。 p = 0.007)。除了与 TNFi 相比，苏金单抗的皮肤病生活质量指数以及银屑病面积和严重程度指数评分显着降低之外，两类生物制剂的临床结果相似。结论 我们首次比较了不同形式的 PsA 生物疗法之间超声确认的附着点炎的效果。我们已经看到两类药物的附着点评分都有所改善，并且与苏金单抗相比，TNFi 的活动附着点疾病有更大的减少，值得进一步探索。