{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T10:59:03Z","timestamp":1793271543467,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"unspecified","delay-in-days":44,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,7,24]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the prevalence of difficult-to-treat psoriatic arthritis (D2T-PsA) and classify patients with persistent inflammatory PsA (PIPsA) and non-inflammatory PsA (NIPsA) based on a combination of clinical and musculoskeletal ultrasound (MSUS) evidence of inflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicentre cross-sectional study was conducted on PsA patients treated with biological disease-modifying anti-rheumatic drugs\/targeted synthetic disease-modifying anti-rheumatic drugs (b\/tsDMARDs). D2T-PsA status was characterised by an inadequate response to \u22652 classes of b\/tsDMARDs and the persistence of active disease, defined as a DAPSA &gt;14.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 517 PsA patients on b\/tsDMARDs, 53 (10.3%) met the criteria for D2T-PsA with 30 (57%) classified as PIPsA and 23 (43%) classified as NIPsA. The PIPsA phenotype had higher swollen joint count (2.5 (IQR 1.0\u20137.0) vs 0.0 (IQR 0.0\u20131.0), p&lt;0.001), dactylitis (20% vs 0%, p=0.030) and nail psoriasis (40% vs 13%, p=0.027). Conversely, NIPsA patients had significantly greater \u0394PtGA\u2013PhGA (4.0 (IQR 2.5\u20135.0) vs 0.0 (IQR 0.0\u20131.5), p&lt;0.001), higher tender points (16.0 (IQR 0.0\u201318.0) vs 0.0 (IQR 0.0\u20138.0), p=0.009), a higher SPARCC enthesitis index (5.0 (IQR 2.0\u20138.0) vs 2.0 (IQR 0.0\u20135.0), p=0.023). The MSUS showed higher ultrasound activity (3.81\u00b12.0 vs 0.91\u00b10.5, p&lt;0.001) and greater structural damage (4.12\u00b11.0 vs 2.38\u00b12.1, p&lt;0.001), with both activity and damage scores being higher in PIPsA patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The classification into PIPsA and NIPsA based on easily detectable clinical features can support a tailored therapeutic management of patients with D2T-PsA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005785","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T10:20:19Z","timestamp":1755166819000},"page":"e005785","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Using ultrasound to define inflammatory and non-inflammatory phenotypes in difficult-to-treat psoriatic arthritis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0573-464X","authenticated-orcid":false,"given":"Alen","family":"Zabotti","sequence":"first","affiliation":[{"name":"Department of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy"},{"name":"NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Cabas","sequence":"additional","affiliation":[{"name":"Department of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Di Nicola","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Italian Society for Rheumatology (SIR), Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Massimo","family":"Perrotta","sequence":"additional","affiliation":[{"name":"Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute \"Vincenzo Tiberio\", Universit\u00e0 degli Studi del Molise, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Guiotto","sequence":"additional","affiliation":[{"name":"Department of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Franzolini","sequence":"additional","affiliation":[{"name":"Presidio Ospedaliero \"S. Antonio\u201d, San Daniele del Friuli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Giovannini","sequence":"additional","affiliation":[{"name":"Department of Medicine (DMED), Rheumatology Division, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"De Martino","sequence":"additional","affiliation":[{"name":"Institute of Statistics, Department of Medicine (DMED), University of Udine, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Isola","sequence":"additional","affiliation":[{"name":"Institute of Statistics, Department of Medicine (DMED), University of Udine, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Di Matteo","sequence":"additional","affiliation":[{"name":"NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching 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