PT - JOURNAL ARTICLE AU - Victoria Furer AU - Jonathan Wollman AU - David Levartovsky AU - Valerie Aloush AU - Ofir Elalouf AU - Hagit Sarbagil-Maman AU - Liran Mendel AU - Sara Borok AU - Daphna Paran AU - Ori Elkayam AU - Ari Polachek TI - Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis AID - 10.3899/jrheum.220547 DP - 2022 Oct 15 TA - The Journal of Rheumatology PG - jrheum.220547 4099 - http://www.jrheum.org/content/early/2022/11/25/jrheum.220547.short 4100 - http://www.jrheum.org/content/early/2022/11/25/jrheum.220547.full AB - Objective To investigate sex-based sonographic differences in patients with psoriatic arthritis (PsA). Methods The study population included consecutive prospectively recruited patients with PsA, as determined by the CASPAR (Classification for Psoriatic Arthritis) criteria, who underwent clinical and physical examinations, followed by a detailed ultrasound (US) evaluation (greyscale and Doppler). US evaluation included 52 joints, 40 tendons, and 14 points of entheses (Modified Madrid Sonographic Enthesis Index [MASEI] plus lateral epicondyles) performed by an experienced sonographer blinded to the clinical data. The US score was based on the summation of a semiquantitative score for synovitis, tenosynovitis, and enthesitis. The US enthesitis score was categorized into inflammatory lesions (ie, hypoechogenicity, thickening, bursitis, and Doppler) and structural lesions (ie, enthesophytes/calcifications and erosions). Results The study population of 158 patients included 70 males and 88 females. The males had higher rates of employment (P = 0.01), Psoriasis Area and Severity Index scores (P = 0.04), and mean swollen joint counts (P = 0.04). The total US score and its subcategory scores—the synovitis and tenosynovitis scores—were similar for both sexes, whereas the total enthesitis score and its subcategory score—the inflammatory enthesitis score—were significantly higher for the males compared to the females (P = 0.01 and P = 0.005, respectively). Hypoechogenicity, thickening, and enthesophytes were more prevalent in males compared to females (P < 0.05). Multivariate ordinal logistic regression models showed that male sex was associated with a higher US inflammatory enthesitis score compared to female sex (odds ratio 1.96, P = 0.02). Conclusion Sonographic enthesitis was more prevalent in males compared to females with PsA. These differences were not reflected by enthesitis disease activity scores derived from clinical assessment.