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Ultrasound, MRI enable early diagnosis of spondyloarthropies in patients with psoriasis
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The use of ultrasound and MRI successfully enabled the early diagnosis of spondyloarthropies other than and in addition to psoriatic arthritis in patients with psoriasis, according to researchers at Al-Minia University Hospital in Egypt.
The researchers studied 50 patients with psoriasis and 20 healthy individuals matched for age and sex. In addition to the collection of full medical history, patients were evaluated using the modified Health Assessment Questionnaire – disability index (HAQ) and assessed physically with the Ritchie articular index (RAI), which included assessment of distal interphalangeal joints. Fingers and nails were examined to identify psoriasis manifestations. Sites presenting with enthesopathy were assessed using Mander, et al. criteria, and the Psoriasis Area and Severity Index (PASI) score was calculated to assess the extent of skin lesions.
The researchers assessed the hands, feet, lumbar spine, sacroiliac joint and wrists of all patients and controls using ultrasound and power Doppler; lumbosacral spine and sacroiliac joint MRI was also performed.
Patients were divided into subgroups based on the presence or absence of arthralgia. In the group of patients with arthralgia, eight men and three women had psoriasis for more than 7 years. Ultrasound revealed psoriatic arthritis (PsA) in seven of 11 patients who presented with ultrasound abnormalities, with joint effusions present in four of the patients. Power Doppler revealed increased vascularity in five patients, and three patients also had abnormal X-rays. Nail score correlated with PsA results, according to the researchers.
In the subgroup of patients without arthralgia (21 mean and 18 women), an insignificantly lower PASI score was seen, but the disease duration was similar to the group with arthralgia. The researchers also found RAI and HAQ differed significantly in each subgroup.
Enthesitis was identified in 37 patients (74%) by ultrasound, and tenderness was seen in 46% on clinical assessment and in 26% on X-ray. Ultrasound detection of enthesopathy was not correlated with age or disease duration but was correlated with the enthesopathy index, RAI and HAQ, according to the researchers.
Inflammatory back pain was seen in 14 patients (28%), and clinical manifestations of sacroiliitis were seen in eight patients. MRI confirmed sacroiliitis in five patients (10%), three of whom had inflammatory back pain. One had mechanical sacroiliitis and one was asymptomatic. Radiologic testing revealed three patients, one of whom had inflammatory back pain. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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