Article Text

PDF

Early diagnostic Achilles tendinopathy in patients with psoriasis and arthralgia
  1. R Sokolik,
  2. B Nowak,
  3. M Ponikowska,
  4. P Wiland
  1. Department of Rheumatology and Internal Disease, Wroclaw University Hospital, Wroclaw, Poland

Statistics from Altmetric.com

Background

Psoriatic arthritis belongs to a group of spondyloarthropaties that are characterised by, among other things, enthesopathy. The most typical enthesitis is heel pain related to inflammation of the Achilles tendon or the plantar fascia insertion. Musculoskeletal ultrasonography is a useful tool for evaluating joint and soft tissue pathology and it can be used to visualise enthesopathy.1,2,3

Objectives

The aim of the study was to assess the frequency of occurrence of Achilles tendinopathy in patients with psoriasis and arthralgia.

Methods

33 patients (16 women) aged 27±72 years (mean age 49.2±11.3 years) with psoriasis (mean disease duration 20.8±12.9 years) and arthralgia were enrolled in the study. In 27 (82%) patients the diagnosis of psoriatic arthritis (mean disease duration 7.6±7.1 years) had already been established. Ultrasound (US) examination of the Achilles tendon and painful joints was performed. All examinations were carried out using a high frequency linear transducer (7±12 MHz, Logiq 5, General Electric). Power Doppler sonography set for high sensitivity was used to detect synovium or tendon hyperaemia.

Results

Only five (15%) patients in our group complained of achillodynia. In one of them (20%) no pathological changes in the Achilles tendon were detected. In the remaining four patients we detected enthesopathy. In 28 patients without achillodynia, US examination of the Achilles tendon region showed Achilles tendon oedema in 8 (29%) patients, insertion hyperaemia in 10 (36%), erosions in 6 (21%), enthesophytes in 9 (32%) and bursitis in 8 (29%). During US examination of painful joints in 20 (61%) out of 33 patients, we detected effusion of at least one joint.

Conclusion

In 80% of patients with achillodynia, US examination reveals Achilles tendinopathy. In 1/3 patients with psoriasis and arthralgia but without heel pain, US detects asymptomatic Achilles tendon enthesopathy. Our results confirm the sensitivity of US in detecting Achilles tendon enthesiopathy and its superiority to physical examination.

References

View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.