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Subclinical joint inflammation in patients with psoriasis without concomitant psoriatic arthritis: a cross-sectional and longitudinal analysis
  1. Francesca Faustini1,2,
  2. David Simon1,
  3. Isabelle Oliveira1,
  4. Arnd Kleyer1,
  5. Judith Haschka1,3,
  6. Matthias Englbrecht1,
  7. Alan Rodrigues Cavalcante4,
  8. Sebastian Kraus1,
  9. Taiane Ponte Tabosa4,
  10. Camille Figueiredo1,
  11. Axel J Hueber1,
  12. Roland Kocijan1,3,
  13. Alexander Cavallaro5,
  14. Georg Schett1,
  15. Michael Sticherling6,
  16. Jürgen Rech1
  1. 1Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 2Clinic of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
  3. 3Medical Department II, St. Vincent Hospital, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
  4. 4CSD Clinica Som Diagnosticos, Belém, Pará, Brazil
  5. 5Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
  6. 6Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany
  1. Correspondence to Professor Georg Schett, Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, Erlangen 91054, Germany; georg.schett{at}


Objectives To search for subclinical inflammatory joint disease in patients with psoriasis without psoriatic arthritis (PsA), and to determine whether such changes are associated with the later development of PsA.

Methods Eighty-five subjects without arthritis (55 with psoriasis and 30 healthy controls) received high field MRI of the hand. MRI scans were scored for synovitis, osteitis, tenosynovitis and periarticular inflammation according to the PsAMRIS method. Patients with psoriasis additionally received complete clinical investigation, high-resolution peripheral quantitative CT for detecting erosions and enthesiophytes and were followed up for at least 1 year for the development of PsA.

Results 47% of patients with psoriasis showed at least one inflammatory lesion on MRI. Synovitis was the most prevalent inflammatory lesion (38%), while osteitis (11%), tenosynovitis (4%) and periarticular inflammation (4%) were less frequent. The mean (±SD) PsAMRIS synovitis score was 3.0±2.5 units. Enthesiophytes and bone erosions were not different between patients with psoriasis with or without inflammatory MRI changes. The risk for developing PsA was as high as 60% if patients had subclinical synovitis and symptoms related to arthralgia, but only 13% if patients had normal MRIs and did not report arthralgia.

Conclusions Prevalence of subclinical inflammatory lesions is high in patients with cutaneous psoriasis. Arthralgia in conjunction with MRI synovitis constitutes a high-risk constellation for the development of PsA.

  • Psoriatic Arthritis
  • Magnetic Resonance Imaging
  • Synovitis

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  • Handling editor Tore K Kvien

  • FF, DS and IO contributed equally to authorship of this paper.

  • MS and JR contributed equally to senior authorship.

  • Contributors DS, FF, IO, AK, JH, SK, AJH, RK, MS, ARC, AC collected the data. DS, FF, ME, IO, AJH, GS and JR analysed and interpreted the data. DS, FF, GS and JR prepared and revised the manuscript.

  • Funding This study was supported by the Deutsche Forschungsgemeinschaft (SPP1468, CRC1181), the Marie Curie project OSTEOIMMUNE, the Metarthros project of the German Ministry of Science and Education, the IMI-funded project BTCure and the Pfizer Competitive Grant Award Germany.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval University of Erlangen-Nuremberg.

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