Medical imaging examination in psoriasis and early psoriatic arthritis patients: an updated systematic review and meta‐analysis

Abstract

Psoriatic arthritis appears in one in four skin psoriasis patients. Early detection of the presence of joint involvement and early interception of its developments may minimize long-term functional disability, and the radiological methods may be a perfect choice. To summarize and compare different imaging methods for diagnosing early-stage psoriatic arthritis and determine the necessity of joint examination in all psoriasis patients, several electronic databases, including MEDLINE and EMBASE, were searched for English language studies. A specific selection criterion followed the retrieval of studies. Thirteen studies were finally enrolled in the meta-analysis, eight of which compared the bone changes presentat on medical imaging examination between psoriasis patients without psoriatic arthritis and healthy people; three studies focused on differences between psoriatic arthritis patients and free joint involvement psoriasis patients shown on medical imaging tests. Medical imaging examination, including ultrasound (US), high-resolution peripheral quantitative CT scans (HR-pQCT), and magnetic resonance imaging (MRI), can be good choices for detecting the start of asymptomatic joint inflammation in psoriasis patients, which is essential to early detection and interception of joint damage to lower joint deformities and improve the future quality of life for patients. Additionally, the examination for psoriasis patients with arthralgia is also highly recommended. Materials and Methods Study searchStudies were searched by two investigators independently from the MEDLINE (using PubMed), EMBASE (using Clinical Key), and Cochrane Library. We also searched electronic databases -National Institutes of Health's Clinical Trials Registry, Cochrane Central Register of Controlled Trials (CENTRAL), and OpenGrey for unpublished studies. Medical Subject Heading (MeSH) terms and text words ("Psoriasis" or "Psoriatic Arthritis" in all search fields) and ("Imaging" and "Radiology" within which the term "Psoriasis" is fully embedded) were utilized for the search on PubMed. For EMBASE, we performed literature searches using exploded words and synonyms for terms:("arthralgia" or "Joint involvement" in Psoriasis) AND ("Imaging Examination" or "MRI" or "Ultrasound"). Both databases were limited to English language studies in human subjects, and the

Evaluation of early joint damage via ultrasound imaging in patients with psoriasis: a single center retrospective study

“…Early screening with imaging tools such as ultrasonography has been widely cited in clinical practice (1,11,12).Overseas studies have found that psoriasis patients have a signi cantly higher incidence of adhesion point and synovitis under high-frequency ultrasound than normal subjects, and in a cohort study of patients with psoriasis there was a positive correlation between age and active synovitis, whereas the gender was male, and high PASI scores were positively correlated with active adhesion point in ammation (15).In this study, the patients presented with subclinical ultrasound damage mostly in the form of synovitis for the following reasons: rstly, studies have shown that the most frequent sites of tendon telangiectasia in patients with psoriasis when the knee joint and Achilles tendon (20).The highfrequency ultrasound data collected in this study were mostly single-handed Doppler soft-tissue ultrasound, so it was di cult to detect lesions in the Achilles tendon. Moreover, the sample size of this study was limited; therefore, it is more than likely to be biased.…”

“…Imaging tools such as ultrasonography and MRI have also been widely cited in the early screening of PsA (1,11,12).High-frequency ultrasound is an imaging technique for detecting PsA in the subclinical stage by evaluating the skin, nails, joints and attachment points of patients with psoriasis (13).Elevated rates of asymptomatic attachment point in ammation, subclinical synovitis in psoriasis patients compared to normal subjects (14)(15)(16).Patients with psoriasis with joint pain in the prodromal phase had elevated rates of tenosynovitis and adhesion point in ammation compared to patients with psoriasis with cutaneous manifestations only, and patients with psoriasis in the prodromal phase who had adhesion point in ammation on ultrasound could progress to PsA (11).…”

Current and Future Challenges for Rehabilitation for Inflammatory Arthritis

“…Thereby, limitations in daily functioning or participation restrictions, that can, apart from disease activity, be related to personal and environmental factors, may thus remain unrecognized. Therefore, there is a need for the development and evaluation of strategies aimed at the early detection of functional disability, its diagnosis and access to appropriate rehabilitation services, as well as on secondary prevention strategies focusing on specific goals for people who can and want to adhere to lifestyle advice and help those who can and want to stay in work [ 61 , 62 , 63 , 64 ]. Regarding the latter, additional education for health professionals delivering lifestyle interventions is likely to be needed, as supporting behavioral changes in patients requires specific professional skills.…”

Psoriasis to Psoriatic Arthritis: The Application of Proteomics Technologies

“…Although existing reviews have already pointed out that imaging methods, such as ultrasound and MRI, can also become a valuable method to detect early the inflammatory lesions of joints, the expensive costs of exam fees and related equipment, and the long waiting time are limitations. Examination time and hard-interpreted imaging results for non-professional clinicians were all hurdles that hamper the prevalence of application on imaging examinations on patients with PsC ( 22 , 25 , 102 ). Consequently, a fast exam kit with an accessible kit becomes more necessary, suggesting an imperative need to explore a possible biomarker.…”

“…Psoriatic arthropathy, an early stage of joint involvement that may not fulfill the PsA diagnostic criteria, is more common than PsA in PsO patients ( 23 ). For those with asymptomatic joint abnormalities, early synovio-entheseal inflammation or bone erosion can be detected by imaging features like ultrasonography or MRI ( 24 , 25 ). However, with these predictors, it is still hard to foresee the possibility of the transition to PsA ( 26 ).…”