Whole-Body MRI Reveals Widespread Inflammation in Early Psoriatic Arthritis

Key Clinical Summary

• Psoriatic arthritis: An exploratory GOLMePsA randomized trial analysis included 93 paired whole-body MRI scans from 31 treatment-naïve patients; median symptom duration was 10.5 months, and 68% had polyarticular disease.
• Baseline whole-body MRI showed widespread, low-intensity peripheral inflammation beyond clinically apparent disease; sacroiliac joint inflammation occurred in 25.8% of patients, and 32.3% had inflammatory spinal changes.
• MRI-WIPE scores improved at weeks 24 and 36 with golimumab plus methotrexate and steroids (−10; −7) and methotrexate plus steroids (−6; −9), with no meaningful between-group differences.

Whole-body magnetic resonance imaging (WB-MRI) detected widespread, low-intensity inflammatory changes in patients with newly diagnosed psoriatic arthritis (PsA), with improvements observed after treatment regardless of therapeutic regimen, according to an exploratory analysis of a randomized clinical trial.

Investigators evaluated treatment-naïve patients enrolled in the GOLMePsA trial, which compared methotrexate (MTX) plus golimumab and steroids with MTX plus steroids. Participants underwent WB-MRI at baseline and again at weeks 24 and 36. Imaging assessments included validated scoring systems for peripheral joints and entheses, hips, knees, heels, sacroiliac joints, and the spine.

The analysis included 93 paired MRI scans from 31 participants with a median symptom duration of 10.5 months. Most patients (68%) had polyarticular disease at enrollment.

Baseline imaging demonstrated inflammatory involvement extending beyond clinically apparent disease. Median MRI-WIPE scores indicated widespread peripheral inflammation, while axial abnormalities were also common. Sacroiliac joint inflammation, defined by a SPARCC score of at least 2, was identified in 25.8% of participants, and 32.3% had inflammatory changes in the spine.

Both treatment groups experienced reductions in MRI-detected inflammation during follow-up. Patients receiving golimumab plus MTX achieved median MRI-WIPE score changes of -10 at week 24 and -7 at week 36, while those treated with MTX plus steroids had median changes of -6 and -9, respectively.

Despite these improvements, investigators found no meaningful differences between treatment groups at either assessment.

The authors concluded that “WB-MRI identified widespread although low intensity inflammation in peripheral joints and enthesis with improvements seen at 24 and 36 weeks and no meaningful differences between treatment arms.”

Reference
De Marco G, Maksymowych WP, Østergaard M, et al. Whole body-MRI identifies widespread, low intensity inflammation in peripheral joints, and axial involvement in a third of patients with early, treatment-naïve, active PsA: data from the GOLMePsA clinical trial. Rheumatology (Oxford). 2026;65(7):keag308. doi:10.1093/rheumatology/keag308