Enthesitis in Psoriatic Arthritis, the Sonographic Perspective

Smerilli, Gianluca; Matteo, Andrea Di; Cipolletta, Edoardo; Grassi, Walter; Filippucci, Emilio

doi:10.1007/s11926-021-01039-1

Cited by 17 publications

(9 citation statements)

References 76 publications

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“…The poor inter-observer reliability in clinical identification of enthesitis and lack of precision in its diagnosis justify the need for alternative imaging modalities, such as magnetic resonance imaging and US. US has many practical ad-vantages over magnetic resonance imaging, such as low cost, ease of access to multiple anatomical sites, and higher sensitivity and specificity for peripheral entheses lesions 24,25 . We evaluated the role of US in the diagnosis of subclinical enthesitis in patients with PsO, factors affecting enthesitis, and progression of enthesitis in patients with PsO at 1-year follow-up, using MASEI scoring.…”

Section: Discussionmentioning

confidence: 99%

Detection of subclinical enthesitis by ultrasonography in patients with psoriasis and controls

Karamanlioglu,

Ozkan,

Emel Ceren Arıkan

et al. 2024

ARP Rheumatol

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Introduction: Psoriasis is a widespread chronic inflammatory skin disease; enthesitis is inflammation of the tendon, ligament, and joint capsule insertion, prevalent in patients with psoriatic arthritis. Objectives: The aim of study to evaluate the utility of the Madrid Sonography Enthesitis Index scoring system for accurate detection of subclinical enthesitis in patients with Psoriasis compared with healthy controls. Another objective was to assess increase in enthesis area and Psoriatic arthritis incidence, in a prospective 1-year follow-up. Method: Patients aged ≥18 years who were diagnosed with Psoriasis, without musculoskeletal complaints, and who did not have any clinical sign and/or symptom of enthesitis and synovitis were included in the study. The patients and healthy controls were evaluated with ultrasonography. Ultrasonography evaluation consisted of the detection of gray-scale enthesitis and power Doppler signal in the enthesis areas. The Madrid Sonography Enthesitis Index scoring system was used to quantify the extent of the sonographic enthesis abnormalities. Results: The mean MASEI score, structure, thickness, erosion, and calcification were significantly higher in the Psoriasis group than in the control group. The mean MASEI score, structure, erosion, and calcification measurements were significantly higher at the last examination when compared to the first examination. The triceps was the most commonly affected tendon in both groups. Conclusion: Ultrasonography is an important tool for diagnosis and follow-up of subclinical enthesitis in patients with psoriasis. Regardless of disease duration and severity, patients should be screened using ultrasonography at yearly intervals.

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Section: Discussionmentioning

confidence: 99%

Detection of subclinical enthesitis by ultrasonography in patients with psoriasis and controls

Karamanlioglu,

Ozkan,

Emel Ceren Arıkan

et al. 2024

ARP Rheumatol

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“…Скованность и ограничение подвижности в суставах отмечались у 27,5 и 26,2% больных псориазом соответственно (по сравнению с 80,0 и 71,2% больных ПА, р < 0,001), у части больных обеих групп встречались боли в спине (у 7,5% больных псориазом и 30,0% больных ПА, р < 0,001), однако большая часть больных в группе псориаза не предъявляла никаких жалоб (65,0% против 0% в группе сравнения, р < 0,001 нагрузка, соответственно, на крупные суставы (у 45,0 и 61,2% больных, р = 0,040) и суставы позвоночника (у 15,0 и 35,0% больных, р = 0,004). По данным разных авторов, поражение связочного аппарата при ПА выявляется раньше, чем воспаление суставных поверхностей, и связано с высокими функциональными нагрузками определенных сухожилий и энтезисов [18,19]. В нашем исследовании при сопоставлении анамнестических данных с наличием изоморфной реакции клинические признаки воспаления сухожилий и энтезисов в сочетании с соответствующим анамнезом были обнаружены у 47,5% в группе больных псориазом и 68,7% в группе больных ПА (р = 0,007), при этом преобладающим признаком оказался тендинит кистей при пальпации (у 40,0 и 63,7% соответственно, р = 0,003%).…”

Section: Discussionunclassified

The role of the traumatic factor and isomorphic reaction in the early diagnosis of psoriatic arthritis

Koreshkova

Hismatullina

2023

Almanac of Clinical Medicine

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Rationale: Evaluation of the role of the deep Koebner's phenomenon and traumatization seems to be a promising direction in the search of the solution for the delayed diagnosis of psoriatic arthritis (PsA) in patients with psoriasis. We have put forward the question if joint and ligament abnormalities induced by a trauma or persistent physical activity could be an analogue of the skin isomorphic reaction in psoriasis. Aim: To identify joint and ligament abnormalities in patients with psoriasis caused by mechanical stress and their association with the deep Koebner's phenomenon and PsA. Materials and methods: This was an open-label, non-randomized, comparative study in parallel groups in 80 in-patients with psoriasis (recruited in the Dermatovenereological clinic № 1, Ufa); the control group included 80 in-patients with PsA. All patients were assessed by a dermatovenereologist, including past history, severity of psoriasis, degree of PsA activity, special questionnaires and the presence of an isomorphic reaction in the skin and periarticular tissues. The joints with maximal physical activity were assessed by X-ray. PsA was diagnosed by a rheumatologist. Results: The patients from both groups were matched in terms of age, gender, and duration of psoriasis. Pain, joint stiffness and limitation of mobility were present not only in the PsA group, but also in the patients with psoriasis (35%, 27.5% and 26.2% of the patients, respectively). Despite most of the patients in the psoriasis group had no active complaints (65.0% vs. 0% in the control group, p 0.001), clinical signs of inflammation of the tendons and entheses and relevant history were found in 47.5% (68.7% in the control group, p = 0.007). Hand tendinitis was most prevalent symptom in both groups: 40.0% (32/80) in the psoriasis group and 63.7% (51/80) in the PsA group (p = 0.003). Achilles tendon lesions were found in 17.5% (14/80) and 52.5% (42/80) (p 0.001) and periarticular edema in 27.5% (22/80) and 63.7% (51/80), respectively (p 0.001). The combination of these signs with psoriatic plaques in this area was observed in 32.5% (26/80) and 92.5% (74/80) of the patients, respectively (p 0.001). The comparison of the clinical and X-ray data showed that 38 patients with psoriasis and newly diagnosed PsA had had an increased physical load on the affected joints, as well as signs of a deep isomorphic reaction (tendinitis, periarticular edema, or enthesitis near the involved joints). In both groups, the most common form of PsA was distal one (63.2% [24/38] of the patients with newly diagnosed PsA and 58.7% [47/80] of the patients with previously diagnosed PsA, p = 0.648). Conclusion: Involvement of the periarticular tissues, as well as early, including preclinical, X-ray abnormalities in the joints of patients with psoriasis can be associated with increased physical activity and the deep Koebner's phenomenon. Therefore, even if patients with psoriasis do not have any clinical manifestations of PsA and no complaints when seen by a dermatovenereologist, it is recommended to perform a detailed collection of past history data with clarification of the type of physical activity and past trauma, as well as to examine both by inspection and palpation the periarticular tissues (tendons and entheses), for the timely use of X-ray examination, consultation of a rheumatologist aimed at diagnosis of psoriatic arthritis.

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“…[ 23 ] Ultrasound can be used to visualize morphostructural and vascular abnormalities indicative of entheseal inflammation, and it has been proven to be reliable for the evaluation of peripheral entheses in PsA. [ 24 ] Conversely, MRI allows for a comprehensive assessment of enthesitis at both peripheral and axial levels. Guo et al [ 25 ] found that enthesitis was more commonly detected by whole-body MRI than by clinical assessment in patients with spondyloarthritis.…”

Section: Discussionmentioning

confidence: 99%

Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR)

Yang

Liu

et al. 2022

Chinese Medical Journal

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Background: The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts. Methods: Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts. Results: In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 2.8 (range: 1.018.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.593.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.011.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.011.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs' (csDMARDs) use. Conclusions: Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.

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Enthesitis in Psoriatic Arthritis, the Sonographic Perspective

Cited by 17 publications

References 76 publications

Detection of subclinical enthesitis by ultrasonography in patients with psoriasis and controls

Detection of subclinical enthesitis by ultrasonography in patients with psoriasis and controls

The role of the traumatic factor and isomorphic reaction in the early diagnosis of psoriatic arthritis

Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR)

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