A high‐resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: Are they the same?

Abstract

Objective. Distal interphalangeal (DIP) joint arthropathy is characteristic of both psoriatic arthritis (PsA) and osteoarthritis (OA), but the microanatomic basis for DIP joint localization is poorly understood. This study used high-resolution magnetic resonance imaging (MRI) to investigate the basis for hand disease localization in both conditions. Methods. Twenty patients matched for disease duration (10 with DIP joint PsA and 10 with DIP joint OA) and 10 normal control subjects were scanned with a 1.5T MRI scanner utilizing a high-resolution 23-mm diameter surface coil with displayed pixel dimensions of 80-100 m. Images were obtained precontrast and postcontrast, and all joint structures, including ligaments, tendons, and entheses, were evaluated by 2 independent assessors.Results. PsA could be distinguished from OA on the basis of more severe inflammation in the collateral ligaments and the extensor tendons and more severe changes at the corresponding DIP joint entheseal insertions. A much greater degree of extracapsular enhancement, with diffuse involvement of the nailbed and diffuse bone edema without cartilage damage, was also typical of PsA. Compared with the normal controls, the OA cohort exhibited prominent ligament and entheseal changes, but with much less contrast enhancement than in PsA and less bone involvement at the insertions.Conclusion. These findings suggest prominent inflammatory changes in ligament, tendon, enthesis, and adjacent bone in the DIP joint disease of PsA patients. Involvement of the same structures is common in the DIP joints of OA patients, but inflammatory changes are much less marked. These findings are potentially important for a better understanding of arthritis in humans.

Knee Enthesitis and Synovitis on Magnetic Resonance Imaging in Patients with Psoriasis without Arthritic Symptoms

“…In established cases of PsA, Jevtic and coworkers 16 using MRI described inflamed tissue in the hand joints extending far beyond the joint capsule, thickened collateral ligaments, and surrounding periarticular soft tissue, a pattern that is quite different from that observed in patients with RA. In another report, Tan, et al 17 showed, using MRI, prominent inflammatory changes in ligament, tendon, enthesis, and adjacent bone in the distal interphalangeal (DIP) joints of patients with PsA, and similar findings were observed in DIP joints among patients with osteoarthritis (OA) but to a lesser extent.…”

Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis

“…The presence of microdamage in normal fingers at sites that are prone to erosion in RA supports the idea that synovitis could exacerbate joint damage and lead to clinically recognizable erosion (Figure 6b). This common biomechanical and functional thread also likely underscores the propensity for periarticular erosions in seronegative arthritis and even OA (15,16). Indeed, it was recognized more than 40 years ago that radiographic erosions tended to occur adjacent to the capsule, but this important anatomic observation went largely unnoticed (17).…”

Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis

“…Although patients with malignant spinal disease also often had RLs present and could be misdiagnosed as having SpA at a vertebral level, this was in fact a very uncommon misdiagnosis at the patient level, since the overall MRI picture was clearly indicative of malignant disease, due to spinal imaging features elsewhere ( Figure 5). We have previously noted that the MRI pattern of disease in the DIP joints in patients with PsA and those with OA is often similar (14). Recent findings from a non-fatsuppressed MRI study also suggested some potential overlap in chronic changes between SpA and spinal OA (42).…”

“…We have previously studied distal interphalangeal (DIP) joint disease in 2 distinctly different conditions, psoriatic arthritis (PsA) and osteoarthritis (OA), and found that MRI patterns of disease were difficult to differentiate, because the entheseal and bone-related changes were similar (14). We therefore assessed the pattern of MRI lesions typically noted in SpA across 3 major causes of chronic back pain, the clinically confirmed European Spondylarthropathy Study Group (ESSG) criteria for SpA (15), degenerative spinal arthritis (DA), and spinal malignancy/metastases, in comparison with a normal control group of subjects without back pain.…”