Improving Imaging Modalities in Early Psoriatic Arthritis: The Role of Ultrasound in Early Diagnosis of Psoriatic Arthritis.

Tania Gudu,Beverly Ng,Catherine Graham,Veda Kudva,Jashmitha Rammanohar,Deepak R Jadon,Hannah Jethwa,Chen Zhang,Mark Sapsford

doi:10.3389/fmed.2021.804695

Abstract

Objective: Despite recent advances, early diagnosis of psoriatic arthritis (PsA) remains a challenge in clinical practice. Ultrasound (US) could be a useful tool for the diagnosis and management of PsA. The objective of this review was to determine the role of US in early diagnosis of PsA.Methods: We have performed a literature review aiming to evaluate studies on US findings in psoriasis and their predictive value of progression to PsA, as well as studies on US features specific for PsA in comparison with other conditions.Results: A total of 40 studies were included. Sixteen studies assessed US findings in psoriasis, of which only 3 prospectively evaluated the role of US in predicting progression to PsA. Patients with PsA had a greater frequency of US abnormalities, in particular enthesitis and Power Doppler(PD) signal compared to patients with psoriasis only. In the longitudinal studies, psoriatic patients with higher enthesopathy scores at baseline were more likely to progress to PsA. Twenty-four studies evaluated US abnormalities in PsA and compared them to other conditions. Most specific US features that distinguish PsA from psoriasis were PD signal and erosions in joints and entheses. Extra-synovial changes, including peri-tendinous dermal soft tissue oedema with associated PD signal and flexor tendon enthesopathy, as well as thickening of the pulleys in the flexor tendons were highly characteristic for PsA, as they were frequently found in PsA patients, but in none of the RA patients. US-detected entheseal abnormalities in particular erosions and PD signal were more frequent in patients with PsA compared to fibromyalgia.Conclusion: Despite the wide use of US in PsA, more research is needed to identify predictive factors of progression to PsA in patients with psoriasis, as well as to determine most specific US features that differentiate PsA from other conditions.

Highlights

Psoriatic arthritis (PsA) is estimated to affect between 0.3 and 1% of the population but its prevalence among patients with cutaneous psoriasis varies between 6 and 42% [1]
As a “real-time” imaging modality it allows the clinician to be able to focus on symptomatic sites which may improve sensitivity and the ability to use grayscale assessment in addition to Power Doppler (PD) provides added benefits [7]
Power Doppler enthesitis is a frequent finding in active axial spondyloarthritis and PsA, but there is no significant difference between the two conditions

Summary

Introduction

Psoriatic arthritis (PsA) is estimated to affect between 0.3 and 1% of the population but its prevalence among patients with cutaneous psoriasis varies between 6 and 42% [1]. The heterogeneity of symptoms, in addition to the lack of serum diagnostic biomarkers as opposed to rheumatoid arthritis (RA), may contribute to a possible diagnostic delay and many patients with PsA can remain undiagnosed for many months or even years [2, 3]. Such delays in diagnosis and treatment initiation can result in progression of clinical and radiological damage, resulting in poorer longterm disease outcomes and impact dramatically on physical function and quality of life [4]. As a “real-time” imaging modality it allows the clinician to be able to focus on symptomatic sites which may improve sensitivity and the ability to use grayscale assessment in addition to Power Doppler (PD) provides added benefits [7]

Results

Discussion

Conclusion