[Subclinical Involvement of hands and feet joints in psoriasis patients: ultrasonography and magnetic resonance imaging study]

Objective: To evaluate musculoskeletal ultrasound [MSUS] in the detection of subclinical hands and feet joint involvement in psoriasis patients by comparison with magnetic resonance imaging [MRI]

Methods: Thirty Patients with plaque psoriasis with no clinical or radiological signs of arthritis attending outpatient dermatology clinic of Assiut University Hospitals were enrolled in the study. All patients underwent clinical examination [including dermatological and rheumatological examination], MSUS, RI, X-ray evaluation of the hands and feet joints

Results: Both MSUS and MRI were sensitive in detecting subclinical joint inflammation [synovitis], and bone abnormalities in psoriatic patients with normal conventional radiographs. Of the total examined is [2520], synovitis was detected by MSUS in 23.69%, erosions in 9.04%, and bone proliferation in 22.14%. MRI detected synovitis in 15.83%, erosions in 0.75%, and bone marrow edema in 1.35%. A significant correlation was found between the subclinical psoriatic arthritis detected by MSUS with the presence of nail psoriasis

Conclusion: Both MSUS and MRI were sensitive in detecting significant prevalence of subclinical involvement in hands and feet joints of psoriasis patients, this suggests that PsA could be a much more common disorder than was previously suspected. When comparing MSUS with MRI, MSUS identified more synovitis and erosions, and osteoproliferation was only detected by MSUS, whereas bone marrow edema was detected only by MRI

Alterations of the mononuclear inflammatory cells: cd4, cd8 T lymphocytes, IL-1beta, IL-17 and TNF-alpha in RA and OA blood and synovial fluid

Background: Rheumatoid [RA] and osteoarthritis [OA] are common joint diseases. The former is a multisystem disease with underlying immune mechanisms. The latter is a debilitating, progressive disease of diarthrodial joints associated with the aging process. We hypothesize that the development of RA and OA is associated with alterations in T cell subsets [CD4/CD8] as well as cytokine production in the blood and synovial fluid

Objectives: We carried out this investigation to test this hypothesis. Also, we took an aim at analyzing of RA and OA patients for: 1] the clinicopathologic characteristics of the lesions, 2] immunologic alterations in the synovial fluid [SF], peripheral blood [BP] and 3] the correlation between the clinicopathologic characteristics and immunologic alterations

Methodology: Samples [PB, SF] were obtained from 24 RA, 15 OA patients and six age and sex matched healthy controls [HCs]. The CD4/CD8 lymphocytes, levels of TNF-alpha, ILI -1beta and IL-17 cytokines were examined in SF and serum using Enzyme Linked Immunosorbent Assay, and immunoperoxidase staining methods

Results: The mean ages of RA and OA patients were 34.3 +/- 1.7 and 51.1 +/- 2.0 year. In RA, the mean values of the morning stiffness, pain scale, grip strength and Richie articular index were 87.5 +/- 11.5. 6.5 +/- 0.5, 51.0 +/- 8.8 and 29.5 +/- 2.4, respectively. As compared to HCs, in RA and OA, respectively, there were statistically significantly [p<0.05] higher: 1] ESR1 [8.5 +/- 51vs. 33.9 +/- 2.8 vs. 62.3 +/- 6.8]; 2] ESR2 [13.3 +/- 2.1vs. 50.6 +/- 4.3 vs. 88.9 +/- 6.4]; and 3] cytokine levels in the serum [7.5 +/- 2.1 vs. 25.8 +/- 2.3 vs. 26.2 +/- 1.5 for TNF-alpha; 9.2 +/- 6.2 vs. 18.5 +/- 1.6 vs. 17.8 +/- 1.3 for lL-1beta; and 0.01 +/- 0.0 vs. 0.07 +/- 0.02 vs. 0.2 +/- 0.1 for IL-17]. As compared to· OA, RA had significantly higher [p <0.05] cytokine levels in SF [105.6 +/- 39.5 vs. 245.2 +/- 22.2 for TNF-alpha; 14.3 +/- 1.3vs. 26.8 +/- 4.1 for lL-1beta and 0.5 +/- 0.2 vs. 6.4 +/- 2.3 for IL-17]. In the blood, as compared to HCs, there were a statistically significant higher CD4, CDS and CD4/CD8 ratio in both RA and OA [p<0.05]. There were significant direct correlations between the disease activity vs. TNF-alpha; CD4 vs. IL-17; CD8 vs. IL-1beta; and CD4 vs. TNF-alpha in SF

Conclusions: CD4/CD8 lymphocytes, cytokine are altered in RA and OA. In RA, some of these alterations correlated with the underling disease process and therefore may have pathogenetic, modulatory and potential prognostic roles in these lesions