AB0964 Dactylitis Ultrasonographic Features Correlation to Dermatological, Genetic and Activity Indices in Early Psoriatic Arthritis Patients

Abstract

Background In early phase of Psoriatic arthritis (ePsA), US abnormalities might be sub-clinical and independent to psoriasis. Objectives To investigate the ultrasonography (US) dactylitis abnormalities in early PsA patients and to compare them to dermatological, genetic and activity indices. Methods 112 early PsA diagnosed with CASPAR criteria, were studied with MyLab70 Xview (linear probe 15 MHz) US examination of hand fingers. At US, were evaluated the Power Doppler positive synovitis (PS), the tenosynovitis-peritendinitis (TP) of flexors/extensors and the pseudotenosynovitis (PT) (PD subcutaneous signal around flexor tendons) and their correlation with dermatological (presence/absence of psoriasis, presence/absence of palmar psoriasis, presence/absence of nail dystrophy, PASI), genetic (positivity/negativity of HLAB27, B35, B38, CW6, CW7, DR1, DR4) and activity indices (BASDAI, HAQ modified for spondyloarthritis [SHAQ], normality or elevation of ESR, CRP). Results At US, in ePsA, US abnormalities at fingers were present in different percentage: 25,9% (29/112) PD positive synovitis (PS), 17,8% (20/112) tenosynovitis-peritendinitis (TP), 14,3% (16/112) pseudotenosynovitis (PT). At Yates X square test analysis, US parameters correlated to the presence of these three parameters: psoriasis (all p<0,0001), palmar psoriasis (PS p<0,005), nail dystrophy (PS p<0,05, PT p<0,0001), B27 (PS p<0,0001, TP p<0,01, PT p<0,05), B35 (PS p<0,05), B38 (PS p<0,0001, TP p<0,0001, PT p<0,005), CW7 (PS p<0,0001), DR4 (PS p<0,0001, TP p<0,0001, PT p<0,005), CRP (all p<0,0001), ESR (PS p<0,0005, TP p<0,0001, PT p<0,0001). At Pearson correlation, US abnormalities are independent to PASI, BASDAI and SHAQ. Conclusions Dactylitis US abnormalities are correlated to the presence of psoriasis, HLA aplotypes B27-B35-B38-CW7-DR4 and CRP/ESR elevation, while are independent to severity of dermatologic involvement and clinical indices. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4283

Auto-reactions, autoimmunity and psoriatic arthritis

“…Actually, no trigger antigen was detected in PsA patients. Specific autoantibodies in PsA have not been described, and RF or ACPA have been detected only in a small proportion of patients[23]. According to our results, we can speculate that…”

Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis

“…Moreover, Bandelli et al analyzed wrist and hand US abnormalities in 112 early PsA patients and showed that STE (also called Pseudotenosynovitis) was detected in 68/1120 (6.1%) fingers including 52/68 (76.5%) fingers without clinical dactylitis, suggesting a potential role of this lesion in the genesis of dactylitis and that it could be considered as a preclinical marker of dactylitis 12 . However, we did not find a significant correlation between STE and disease duration in our study ( r = .390, P = .089).…”

“…PTI was characterized by hypoechoic swelling of the soft tissue, surrounding the extensor digitorum tendon, with or without peri‐tendinous PD signal 15 . STE was defined as a diffuse enlargement of soft tissue around the flexor tendon, with an increased PD signal, from finger pad to MCP joint 11,12,18 …”

“…In fact, US of entheses, particularly of the lower limbs, showed its usefulness in the diagnosis of spondyloarthritis (SpA) 7–10 . More recently, several studies evaluated the involvement of the SEC at the level of small joints of the hands and highlighted the specificity of several extrasynovial US findings for PsA such as enthesitis, peritendon inflammation of extensor digitorum tendons (PTI), and soft tissue edema (STE) 11–14 …”

Ultrasonographic Evaluation of Entheseal Fibrocartilage in Patients with Psoriatic Arthritis, Athletes and Healthy Controls: A Comparison Study

“…PDUS was found to perform better than clinical examination for detecting entheseal abnormalities, but there is a considerable discrepancy between the clinical and PDUS findings, with less than 50% of clinically tender entheses being related to inflammatory enthesitis when assessed using ultrasound [ 6 ]. On the other hand, entheseal abnormalities could be found in asymptomatic PsA, in patients with early PsA and in psoriasis alone [ 7 , 8 , 9 , 10 ].…”