Background Clinical measures are widely used in established psoriatic arthritis (PsA) but in early phase of disease, often fail to identify the joint and tendons involvement.
Objectives To investigate the ultrasonography (US) abnormalities in hands and wrists of early PsA patients and to compare them with clinical evaluation
Methods We performed a retrospective study on 112 early PsA (onset of inflammatory symptoms lower than one year) in the period 2008-2010, diagnosed with CASPAR criteria(1). Data were carried out by the analysis of medical records of all patients, completed of demographic data, historical information, clinical (swollen joints and dactylitis count) and MyLab70 Xview (linear probe 15 MHz and PRF 1 Mhz) and US (Power doppler [PD] positive synovitis, erosions, tenosynovitis and PD in soft tissue around flexor finger tendons) hands and wrists assessment.
Results Out of 224 wrists and 1120 MCP, 1120 PIP and 1120 DIP totally observed, synovitis was more frequently found on wrist (50/224; 22,3%) and US resulted more sensitive than clinical evaluation (swollen joints): in wrists 50/224 (22,3%) vs 42/224 (18,7%), in MCP 28/1220 (2,5%) vs 11/1120 (1%), in IPP 24/1120 (2,1%) vs 15/1120 (1,3%), in IPD 3/1120 (0,3%) vs 1/1120 (0,09%). Also erosions were present only in MCP (mostly II e III MCP) in 10/1120 joints (0,9%). At US, PD signal in soft tissue around tendons (68/1120, 6,1%) was more frequent than tenosynovitis of flexors (29/1120, 2,6%) and were both found also in patients without clinical dactilitis (55/68 PD [80,8] of soft tissue and 18/29 [62%] of tenosynovitis).
Conclusions In early PsA, US detected synovitis (more frequently at wrists), erosions and PD signals in soft tissue are present in early phase of PsA. In all cases, US is more sensitive than clinical evaluation to detect synovitis and dactilytis.
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73.
Disclosure of Interest None Declared