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Assessment of enthesis in patients with psoriatic arthritis and fibromyalgia using clinical examination and ultrasound


Senior Member
35% FM patients have ultrasound objectivable polyenthesitis:

Assessment of enthesis in patients with psoriatic arthritis/PsA and fibromyalgia/FM using clinical examination and ultrasound


Clinical evidence of enthesopathy was found in
43% of the patients with Psoriatic Arthritis,
51.3% of those with PsA-FM,
and 50.8% of those with FM,

while ultrasound/US entheseal abnormalities were detected in respectively
and 35%.

There was a correlation between GUESS scores/Glasgow Ultrasound Enthesitis Scoring System and disease duration in the patients with PsA or PsAFM, but not in the FM group,
and GUESS scores correlated with BMI and dyslipidaemia (rho=0.34; p=0.006, 95% CI 0.11-0.58 in all three groups.

The use of a clinical examination and clinimetric scores alone may overestimate active enthesitis in FM patients.
As US was more frequently positive in patients with PsA and PsAFM than in those with FM, it may be useful in differentiating pain due to enthesitis from entheseal pain due to FM.


Senior Member
I wonder if Fibro may be a kind of psoriatic arthritis limited to entheses inflammation...or if fibromyalgia's allodynia may allow subclinical psoriatic arthritis limited to entheses to become a clinical disease...

Comorbid fibromyalgia impairs the effectiveness of biologic drugs in patients with psoriatic arthritis
Florenzo Iannone, Mariangela Nivuori, Marco Fornaro, Vincenzo Venerito, Fabio Cacciapaglia, Giuseppe Lopalco
Rheumatology, Volume 59, Issue 7, July 2020, Pages 1599–1606, https://doi.org/10.1093/rheumatology/kez505



To evaluate the impact of FM on the clinical outcomes of biologics in patients with PsA in real life.
FM was diagnosed according to current criteria among PsA patients starting a first biologic drug from 2010 through 2017. At each visit, disease activity of PsA (DAPSA), minimal disease activity (MDA), HAQ, rate of patients achieving DAPSA-based low disease activity (LDA) or remission, and MDA were evaluated. Lost patients or those not achieving the target were imputed as non-responders. The drug survival was evaluated by Kaplan–Meyer analysis. Estimated hazard ratios (HRs) of discontinuing therapy or achieving MDA were assessed by multivariate regression models.

A total of 238 patients, of whom 58 had also FM, started a first biologic drug. Compared with no-FM PsA, FM PsA patients were more frequently female (P = 0.0001) with polyarticular subset (P = 0.0001), and with higher mean BMI (P = 0.006). Drug survival was significantly lower in FM PsA (50%, mean 32 months) than in no-FM PsA (74%, mean 42 months, P = 0.0001). Rates of remission/LDA and MDA were significantly lower in FM PsA at 3, 6, 12 and 24 months (P < 0.001). Remission in FM PsA was negligible (3.4% and 0% at 3 and 6 months, respectively). Negative predictors of drug discontinuation were no FM (HR 0.51) and normal weight (HR 0.29), while no FM (HR 2.54) and male sex (HR 1.58) were positive predictors of long-standing MDA.

Comorbid FM, along with female gender and obesity seem to be the worst combination of negative prognostic factors in PsA.