The following is a summary of the “Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis,” published in the February 2023 issue of Rheumatology by Furer, et al.

To examine whether or not there are sonographic differences between the sexes among psoriatic arthritis patients (PsA). Patients with PsA, as diagnosed by the CASPAR (Classification of Psoriatic Arthritis) criteria, were included in the study after they were prospectively recruited and subjected to a battery of diagnostic tests, including a thorough ultrasound (US) assessment (greyscale and Doppler). An experienced US evaluator blinded to the clinical data looked at 52 joints, 40 tendons, and 14 entheses (the Modified Madrid Sonographic Enthesis Index [MASEI] plus the lateral epicondyles). In addition, semiquantitative scores for synovitis, tenosynovitis, and enthesitis were added to form the US score. 

The US enthesitis score was divided into two groups: inflammatory lesions (such as hypoechogenicity, thickening, bursitis, and Doppler) and structural lesions (such as enthesophytes/calcifications and erosions). Around 70 men and 82 women made up the total study population of 158 people. Employment rates were higher among the males (P = 0.01), as were Psoriasis Area and Severity Index scores (P = 0.04) and the mean number of swollen joints (P = 0.04). 

Males had a higher total enthesitis score and a higher inflammatory enthesitis score than females (P = 0.01 and P = 0.005, respectively), while synovitis and tenosynovitis scores were similar for both sexes. Males had a significantly higher incidence of hypoechogenicity, thickening, and enthesophytes than females (P< 0.05). The odds of having a score of US inflammatory enthesitis greater in males than in females were found in multivariate ordinal logistic regression models (odds ratio 1.96, P = 0.02). Men with PsA were more likely to experience sonographic enthesitis than women. Scores of disease activity for enthesitis that were derived from clinical evaluation failed to reflect these variation.

Source: jrheum.org/content/50/2/197