Ultrasonography in clinical assessment of inflammatory and destructive changes in patients with psoriatic arthritis

To investigate the presence of asymptomatic entheseal abnormalities in psoriatic patients in an attempt for preclinical detection of psoriatic arthritis before joint affection becomes established. study included 50 patients who were divided into 2 groups; group I included 20 psoriatic patients with established psoriatic arthritis [as a control group] and group II included 30 psoriatic patients who didn't have any rheumatologic manifestations. Clinical assessment, routine laboratory studies, rheumatoid factor assessment, routine X-ray, musculoskeletal ultrasound [US], and power Doppler sonography were performed to all patients. US detected changes in 53.3% of psoriatic patients. The most common was inactive synovitis [53.3%], followed by tenosynovitis of flexor and extensor tendons of the hand [33.3%], then achillis tendinitis in 20%, and active synovitis along with achillis bursitis to be 6.7% for each. It was found that the PASI score and CRP were statistically higher in psoriatic patients with US findings than those with no US findings [p<0.05]. Higher tilers of CRP were associated with more synovitis, effusion, achillis tendinitis and bursitis in psoriatic patients; yet CRP tilers did not have in effect on US findings in patients with arthritis. It was found that active joint disease was significantly associated with joint spurs. US could detect subclinical musculoskeletal changes in asymptomatic psoriatic patients, and these changes are related to active skin disease and high levels of inflammatory markers. That is why proper control of skin disease and regular US follow up may lead to early, subclinical diagnosis of psoriatic arthritis and hence, early intervention to prevent joint destruction