Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

Abstract

The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd–5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP] joints, and distal interphalangeal [DIP] joints) and 1st–5th metatarsophalangeal joints of both hands and feet were assessed with US for the presence of synovitis, bone erosions, bone proliferations, and capsular/extracapsular power Doppler signal (only in the PIP joints). The 2nd–5th flexor and extensor tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer. US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high absolute agreement (85% to 100%) for all destructive changes and a more moderate absolute agreement (73% to 100%) for the inflammatory pathologies were found between US and MRI. US detected a higher frequency of DIP joint changes in the PsA patients compared with RA patients. In particular, bone changes were found exclusively in PsA DIP joints. Furthermore, bone proliferations were more common and tenosynovitis was less frequent in PsA than RA. For other pathologies, no disease-specific pattern was observed. US and MRI have major potential for improved examination of joints, tendons, and entheses in fingers and toes of patients with PsA.

Concepts in monitoring enthesitis in patients with spondylarthritis- the role of musculoskeletal ultrasound

“…Generally, the reading reliability was good but with less satisfactory results for acquisition reliability [3,4,23,25,32,34,38,41,44,47,48,51,54,55,61,65,73].…”

“…The scoring systems are used for diagnostic purposes [4,25,47] or for responsivness evaluation [48][49][50]. Some authors proposed semiquantitative grading systems based on grey scale modifications with or without, including PD changes, others developed quantitative scores proposing a cutt off value for differentiating between SpA patients and controls.…”

“…Fewer studies demonstrated the criterion valid-ity and construct validity [3,4,[23][24][25]34,38,47,51,[57][58][59][60][61][62][63][64][65][66][67][68][69][70] where comparators were clinical examination, MRI, XRay, and histology. The lack of information is partially explained because of the difficulties in finding the best comparator, the relatively new use of ultrasound in SpA, and a slow rate of disease progression [5,71,72].…”

Could nail and joint alterations make the difference between psoriatic arthritis and osteoarthritis during the ultrasonographic evaluation of the distal interphalangeal joints?

“…In particular bone erosion and bone proliferation, which were absent in RA, were seen in 4% and 13% of PsA patients, respectively. Tendon insertion abnormalities were also found more frequently in PsA [7].…”

A detailed comparative study of high‐resolution ultrasound and micro–computed tomography for detection of arthritic bone erosions

“…With US one can quantitatively assess the morphologic (synovial thickness) and functional (blood flow) changes of joints during inflammatory arthritis (1)(2)(3)(4). Several studies have shown that US is a sensitive instrument for depicting synovial inflammation in patients with RA (5,6).…”