A Prospective Study to Assess the Efficacy of IL-17 Inhibitors on Subclinical Enthesitis in Patients With Moderate to Severe Psoriasis Based on Power Doppler (PD) Ultrasonography (PDUS)

Glasgow Ultrasound Enthesitis Scoring System (GUESS) is an ultrasonographic score of lower limb enthesitis including superior pole of the patella-quadriceps tendon enthesis, inferior pole of the patella-proximal patellar ligament enthesis, tibial tuberosity-distal patellar ligament enthesis, superior pole of the calcaneus-achilles tendon enthesis and inferior pole of the calcaneus-plantar aponeurosis enthesis, composed of assessments of degenerative changes such as tendon thickness, existence of enthesitis, bursitis, or erosions. It is calculated as follows: one point was scored for each abnormality at each site examined, giving a possible maximum total score for both lower extremities 36. A higher score of GUESS represents more serve inflammation and involvement of enthesis while a lower score represents better outcomes.

Complete resolution of enthesitis from baseline to week 24 based on enthesis assessed by GUESS. It means the percentage reaching a score of 0 for each enthesis. Higher percentage represents higher improvement.

Complete resolution of enthesitis from baseline to week 52 based on enthesis assessed by GUESS. It means the percentage reaching a score of 0 for each enthesis. Higher percentage represents higher improvement.

New bone erosion, bursitis, osteophytes at week 24 based on enthesis assessed by GUESS. It means the percentage that the score changes from 0 to 1 in the item of 'erosion, bursitis, osteophytes' for each enthesis. Higher percentage represents more worsening of inflammation.

New bone erosion, bursitis, osteophytes at week 52 based on enthesis assessed by GUESS. It means the percentage that the score changes from 0 to 1 in the item of 'erosion, bursitis, osteophytes' for each enthesis. Higher percentage represents more worsening of inflammation.

Change of patient pain assessment based on Visual Analog Scale (VAS) at week 4, 12, 24, 36, 52. The pain VAS is a continuous scale comprised of a horizontal (HVAS) line, usually 10 centimeters (100 mm) in length, anchored by 2 verbal descriptors. For pain intensity, the scale is anchored by "no pain" (score of 0) and "worst imaginable pain" (score of 100 [100-mm scale]). Higher score represents more severe pain.

The Psoriasis Area and Severity Index Score (PASI) is a physician assessment that combines the assessment of the severity (erythema, induration and desquamation) of and area affected by psoriasis into a single score in the range 0 (no disease) to 72 (maximal disease). The higher the score the more severe the psoriasis.

Body Surface Area (BSA) is a measure of how much skin is impacted by psoriasis and can be used to track an individual's psoriasis over time. For context, one handprint is equal to approximately 1 percent BSA. Involvement of <3% BSA is considered mild, 3%-10% BSA is considered moderate and >10% of BSA is considered severe psoriasis.

The mNAPSI is a tool for physicians to evaluate the severity of nail bed psoriasis and nail matrix psoriasis by area of involvement in the nail unit. Each fingernail is rated for the presence and severity of seven features to give a total fingernail score of 0-13 (0= no involvement, 13 = greatest involvement). The total mNAPSI score is the sum of the 10 fingernail scores (range 0-130; 0= no involvement, 130= greatest involvement). The higher the score the more severe the nail bed psoriasis.

The Psoriasis Scalp Severity Index scale (PSSI) rates psoriasis severity on the scalp based on three parameters: erythema (redness), scaling, and thickness. Each parameter is assessed individually, and the scores are combined to provide an overall severity rating. The total PSSI score is a sum of scores for erythema, induration, and desquamation x involved area, ranges 0 (no disease) to 72 (maximal disease). The higher the score the more severe the scalp psoriasis is.

The HAQ-DI is scored on a four-level difficulty scale ranging from zero (normal, no difficulty) to three (unable to do, extreme difficulty). There are 20 questions covering eight domains: dressing, rising, eating, talking, hygiene, reach, grip, and usual activities. The highest score for an item within each domain is taken as the score for that domain; the HAQ-DI total score is the average of the eight domain scores and therefore ranges between 0 and 3. Scores of 0-1 represent mild to moderate difficulty; 1-2 represent moderate to severe disability; 2-3 represent severe to very severe disability.

66/68 swollen and tender joint counts (SJC66/TJC68)

Medial epicondyle (left/right (L/R)) Lateral epicondyle (L/R) Supraspinatus insertion into greater tuberosity of humerus (L/R) Greater trochanter (L/R) Quadriceps insertion into superior border of patella (L/R) Patellar ligament insertion into inferior pole of patella or tibial tubercle (L/R) Achilles tendon insertion into calcaneum (L/R) Plantar fascia insertion into calcaneum (L/R)

Proportion of patients who progressed to PsA at Week 52, based on CASPAR