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Extended report
A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis
  1. Stephanie Finzel1,
  2. Matthias Englbrecht1,
  3. Klaus Engelke2,
  4. Christian Stach1,
  5. Georg Schett1
  1. 1Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 2Institute of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Erlangen, Germany
  1. Correspondence to Professor Georg Schett, Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Krankenhausstrasse 12, Erlangen D-91054, Germany; georg.schett{at}


Background Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are both destructive arthritides but may differ substantially in their periarticular bone changes.

Objectives To investigate the differences in the structural changes of periarticular bone in patients with PsA and RA by a high-resolution imaging technique designed to visualise the bone architecture.

Methods 30 patients with PsA and 58 patients with RA received a µCT scan to compare structural bone changes in the metacarpophalangeal joints of the dominantly affected hand. Number, extent, form and distribution of bone erosions, osteophytes and cortical thinning were recorded. In addition, the size and depth of bone erosions and the size of osteophytes were determined.

Results Patients with PsA and RA had the same number of bone erosions, but they were less severe and overall smaller in size and depth in PsA. Erosions in PsA were mostly Ω-shaped and tubule-shaped, whereas U-shaped lesions were most typical for RA. Erosions in PsA were more evenly distributed, lacking the strong preponderance for the radial sites found in RA. Osteophytes were increased in number, extent and size in PsA as compared with RA, often affecting the entire circumference of bone (‘bony corona’).

Conclusions High-resolution µCT imaging shows profound differences in periarticular bone changes between PsA and RA. Smaller Ω-shaped and tubule-shaped bone erosions as well as large sometimes corona-shaped osteophytes are typical for PsA. These data suggest that mechanisms of bone repair may be more active in PsA than in RA.

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  • Funding This study was supported by the Deutsche Forschungsgemeinschaft (FG 661/TP4 and SPP1468-IMMUNOBONE), the Bundesministerium für Bildung und Forschung (BMBF); ANCYLOSS and IMMUNOPAIN, the MASTERSWITCH, KINACEPT and ADIPOA projects of the European Union, the Interdisciplinary Centre for Clinical Research and the ELAN fund of the University of Erlangen-Nuremberg.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the medical faculty of the Friedrich-Alexander University of Erlangen-Nuremberg, Krankenhausstraße 12, 91054 Erlangen, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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