Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Ultrasound Assessment of Enthesis Thickening in Psoriatic Arthritis Patients Treated with Adalimumab Compared to Methotrexate.

Litinsky1,  Irena, Wollman2,  Jonathan, Balbir-Gurman3,  Alexandra, Arad2,  Uri, Paran4,  Daphna, Caspi2,  Dan, Elkayam2,  Ori

Department of Rheumatology, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Rambam Health Care Campus, Haifa, Israel
Tel Aviv Souraski Medical Ctr, Tel Aviv, Israel


Enthesitis –inflammation of the origin and insertion of ligaments, tendons and aponeuroses is widely accepted clinical and imaging feature of Psoriatic arthritis (PsA). Clinical assessment of enthesitis by eliciting tenderness at the enthesis is inaccurate. Musculoskeletal ultrasound (MSUS) has become the gold standard for examination of tendons and has already been proved to be helpful in monitoring synovitis in RA patients treated with TNF-a antagonists. Evidence for the effect of TNF-a antagonists on ultrasonic features of inflamed enthesis and tendon is still limited. We aimed to assess the effect of adalimumab (ADA) compared to methotrexate (MTX) on the thickness of tendons and enthesis in PsA patients.


Thirty two PsA patients with active PsA were included. Group1: 21 PsA patients starting treatment with ADA: 14 women (66.6%), 7 men (33.4%), mean age 51.9+9.5 years. Group 2: 11 PsA patients beginning MTX: 5 (45.5%) women, 6(54.5%) men, mean age 45.1+14.3 years. The ultrasound (US) assessment and thickness measurement of the extensor (ET) and flexor tendons (FT) of the 2nd and 3rd finger of both hands, plantar aponeurosis (PA) and Achilles tendon (AT) bilaterally were performed on the day of initiating the therapy, 6 and 12 weeks after. Disease activity was assessed by the number of tender (TJ) and swollen joints (SJ), the number of inflamed enthesitis (IE), pain assessment (PA), patient (PDA) and physician (PGDAI) disease activity evaluation by VAS.

Results: Within each Group:

In group 1, all disease activity parameters were improved at visit 3 and reached statistically significant for the number of TJ (10.38 vs 6.06 (P=0.0071)), SJ (8.19 vs 4.94 (P=0.04)), PA (71.52 vs 43.44(p=0.006)) and PGDAI (70.45 vs 40.95(p=0.0014)). Decreased thickness was observed for Achilles tendons bilaterally and was significant for the left side (Rt:0.35cm vs 0.33 (p=0.7) and lt: 0.38 vs 0.33 (p=0.02)), and for left plantar aponeurosis (0.13 vs. 0.1 (p=0.01)) ), while no significant changes were observed for the thickness of flexor and extensor hands tendons.A statistically significant positive correlation was found between the decrease of thickness of the extensor tendons and the number of TJ,number of IE, PGAD, PGA (3rd lt Et –PGA; 3rd rt ET-TJ, IE, PGA;2nd ET –TJ).In group 2, the disease activity parameters of IE (p=0.04), PA (p=0.0079), PGA (p=0.017) and PGDA (p=0.05) decreased significantly, while the number of TJ and SJ did not changed during the follow up period of 3 months. No change was observed in the thickness of both Achilles tendons and plantar aponeurosis, flexor and extensor tendons of hands after 12 weeks. Comparison within groups: Six weeks after initiating treatment with ADA, thickness of left Achilles tendon,2nd rt FT and the number of TJ, SJ, PA, PGA were significantly decreased in comparison to the MTX group (p=0.007;p=0.05 p=0.032; p=0.001;p=0.034 and p=0.003 respectively).


In patients with PsA, treatment with ADA, compared to MTX, significantly improved signs of diseases activity as well as several ultrasonic parameters of enthesis. The US assessment of enthesis is an additional useful tool in the monitoring of psoriatic enthesopathy.

To cite this abstract, please use the following information:
Litinsky, Irena, Wollman, Jonathan, Balbir-Gurman, Alexandra, Arad, Uri, Paran, Daphna, Caspi, Dan, et al; Ultrasound Assessment of Enthesis Thickening in Psoriatic Arthritis Patients Treated with Adalimumab Compared to Methotrexate. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1300

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