Abstract
We aimed to explore the accuracy of physical examination (PE) to detect the synovial and extra-synovial pathologies in psoriatic arthritis (PsA) in comparison to ultrasonography (US). Twenty-nine PsA patients with hand pain were included in the study. A detailed PE of the hands was performed and US scans were performed for the joints, extensor and flexor tendons, and entheses of the second to fifth fingers of both hands. The agreement between PE and US findings was calculated. The strongest agreement for the joints was between “swollen joints” and power Doppler (PD) signals in the metacarpophalangeal (MCP) joints and grey scale synovitis in the proximal interphalangeal (PIP) joints. The agreement of tender entheses on PE and inflammation on US (hypoechogenicity, thickening, and/or PD signals) was poor for both extensor (Kappa = −0.027, Prevalence Adjusted and Bias Adjusted Kappa (PABAK) = 0.344) and flexor compartments (Kappa = 0.039, PABAK = 0.569). Similar to enthesitis, comparison of any PE and US findings showed a poor agreement at the extensor and flexor tendon regions (extensor: Kappa = 0.123, PABAK = 0.448, and flexor: Kappa = 0.171, PABAK = 0.431). Our study showed that there was a poor to fair agreement of PE and US findings of hands. US can add value when determining the source of pain in PsA in the small joints.
Highlights
Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory disease with articular and extra-articular manifestations [1]
Our aim was to explore the accuracy of Physical examination (PE) to detect the involvement of synovial and extra-synovial structures of hands in PsA in comparison to ultrasonography as the gold standard, and to determine how often these extra-synovial pathologies lead to symptoms
Our study showed that there is a poor to fair agreement of PE and US findings for the joints, tendons, and entheses of hands, which may all be involved and cause pain in PsA
Summary
Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory disease with articular and extra-articular manifestations [1]. The importance of the identification of structures involved in PsA lies in the efficacy of treatments that can be different for different disease manifestations [7]. None used imaging to differentiate the involvement of different structures or the responsiveness of different pathological lesions in small joints, such as hands and feet, to various treatments [8]. A few studies explored the specificity of extra-articular features in PsA, none of the studies looked at the contribution of these pathologies to pain or the accuracy of PE to distinguish these lesions. Our aim was to explore the accuracy of PE to detect the involvement of synovial and extra-synovial structures of hands in PsA in comparison to ultrasonography as the gold standard, and to determine how often these extra-synovial pathologies lead to symptoms
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