TOPLINE

Ultrasound improved the diagnostic certainty of psoriatic arthritis (PsA) among people with psoriasis and musculoskeletal (MSK) symptoms by 21.9%.

METHODOLOGY

• In an ongoing prospective cohort study designed to externally validate the use of the DUET Ultrasound Enthesitis Score in a real-world setting, researchers are enrolling people with psoriasis and MSK symptoms seen at the Women’s College Hospital in Toronto, Ontario, Canada, with a projected final enrollment of 100-120 participants.
• Participants first underwent clinical examination and indices for spondyloarthritis (Spondyloarthritis Research Consortium of Canada) and enthesitis (Leeds Enthesitis Index) were completed.
• Next, ultrasound examination with DUET scoring was done at six entheses locations and a rheumatologist experienced in MSK ultrasound separately pinpointed a single site of tender “sentinel” enthesitis.
• Finally, to obtain a full clinical picture, participants underwent standardized laboratory testing and radiography of the entheses.
• Diagnostic probability of PsA was scored by the rheumatologist on a scale of 0 (no PsA) to 10 (definite PsA); a score of 7 or higher suggested a clinical diagnosis of PsA.

TAKEAWAY

• So far, 32 participants with psoriasis and MSK symptoms have been enrolled, of whom 12 have been diagnosed with PsA and 20 have not.
• Five (58.3%) of the participants with PsA had enthesitis on clinical examination, but eight of those with PsA (66.7%) had a positive DUET score. This suggested the score was a good imaging biomarker regardless of the clinical result.
• Of the 20 participants with no PsA diagnosis, 13 (65%) had no clinical enthesitis and 12 of them (92.3%) had a negative DUET score. Of the seven (35%) with clinical enthesitis, two (28.6%) had a positive DUET score.
• Diagnostic certainly was 12.5% for clinical assessment alone, 34.4% with added ultrasound and the DUET score, but increased only slightly to 37.5% with added laboratory tests and radiography.
• The mean ultrasound scan time was 7.4 minutes.

IN PRACTICE

“In this pilot study, our preliminary findings suggest that the DUET score may improve the diagnostic confidence of psoriatic arthritis,” said rheumatologist and study investigator Sahil Koppikar, MD. “The DUET score may identify inflammatory enthesitis in patients with psoriasis who lacked peripheral arthritis, potentially facilitating an earlier diagnosis of PSA,” he added.

SOURCE

Koppikar presented the findings at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2026 Annual Meeting and Trainee Symposium, Lisbon, Portugal.

LIMITATIONS

These were early findings from a small ongoing study reported at a conference. The study is being performed in a single-center and even if results continue to be positive for the use of ultrasound as a diagnostic aid, they will need to be replicated in a larger population of patients with longitudinal follow-up.

DISCLOSURES

GRAPPA is funding the study. Koppikar had no relevant conflicts of interest.