Sex-Based Differences in Sonographic and Clinical Findings Among Patients With Psoriatic Arthritis

Victoria Furer, Jonathan Wollman, David Levartovsky, Valerie Aloush, Ofir Elalouf, Hagit Sarbagil-Maman, Liran Mendel, Sara Borok, Daphna Paran, Ori Elkayam, Ari Polachek*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)197-203
Number of pages7
JournalJournal of Rheumatology
Issue number2
StatePublished - 1 Feb 2023


  • enthesitis
  • gender
  • inflammation
  • psoriatic arthritis
  • spondyloarthritis
  • ultrasound


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