Lower limbs enthesopathy in psoriatic patients without clinical signs of arthropathy: a hospital based case-control study

Paolo Gisondi ^1*, Ilaria Tinazzi ², Ghassan El-Dalati ², Mauro Gallo ², Domenico Biasi ², Lisa Maria Barbara ² and Giampiero Girolomoni ²

¹ Univeristy of Verona, Italy
² University of Verona, Italy

^* To whom correspondence should be addressed. E-mail: paolo.gisondi{at}univr.it.

Accepted 8 August 2007

Abstract

Background: Psoriasis is associated to a form of spondyloarthropathy in 10-30% of cases. A major feature of psoriatic arthritis is enthesitis. In some psoriatic patients the presence of enthesitis could be under diagnosed.

Objective: To investigate the presence of lower limbs entheseal abnormalities in patients with chronic plaque psoriasis without signs and symptoms of psoriatic arthritis.

Methods: Thirty psoriatic patients and thirty controls underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS).

Results: Mean GUESS score was significantly higher in patients with psoriasis as compared to controls (7.9 ± 0.6 vs 2.9 ± 0.3; p<0.0001). In particular, the thickness of all tendons examined was significant higher in cases than in controls (p<0.0001), as well as the number of enthesophytes in all sites examined. In both cases and controls, GUESS score was directly correlated with age (r 0.22; p 0.008), body mass index (r 0.23, p 0.0067) and waist circumference (r 0.17; p 0.02). In contrast, GUESS score was not correlated with the duration and severity of psoriasis according to Psoriasis Area and Severity Index (r 0.03; p 0.8) and body surface area involvement (r 0.07; p 0.6).

Conclusions: Entheseal abnormalities can be documented by ultrasonography in clinically asymptomatic psoriatic patients. These findings could be related to a sub-clinical entheseal psoriatic inflammation. We suggest close follow up of psoriatic patients with entheseal abnormalities for early diagnosis of psoriatic arthritis.

Keywords: psoriasis, entheseal abnormalities, Glasgow Ultrasound Enthesitis Scoring System (GUESS score), psor

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