Ultrasound Is Effective as Subclinical PsA Screening Tool
Routine evaluation with ultrasound may be an effective screening tool for subclinical psoriatic arthritis (PsA) in patients with moderate-to-severe psoriasis, according to the results of a recent prospective, multicenter study.
Included were 490 participants with moderate-to-severe psoriasis. Of the total participants, 384 were without arthritis symptoms and were included in the silent psoriasis group. The remaining 106 participants with arthritis symptoms were included in the clinical PsA group. Additionally, 80 individuals without psoriasis were included as part of a control group.
A total of 60 joints, 38 tendons, and 40 entheses were examined in each patient as part of clinical assessment and ultrasound examinations. The researchers compared the incidence of synovio-enthesitis, synovitis, tenosynovitis, erosion, and dactylitis on ultrasound between the groups.
Following significant ultrasound findings, the researchers examined both subclinical PsA and psoriasis alone in the silent psoriasis group. Basic clinical characteristic, body surface area, and Psoriasis Area and Severity Index scores were examined.
The results indicated that only the incidence of synovio-enthesitis was different between the control and silent psoriasis groups (1.3% vs 16.1%, respectively, p <.001). Subclinical PsA was significant in the lower limbs, with 79.0% of cases involving the knee.
The subclinical PsA phase was present in 16.1% of the silent psoriasis group and 13.7% of all patients with psoriasis, when using synovio-enthesitis as the standard. Among the three groups, there were no differences observed in body surface area or Psoriasis Area and Severity Index scores.
“Since the psoriasis patients in [subclinical PsA] phase was as high as 12.7% in all patients with moderate-to-severe psoriasis, [ultrasound-detected] synovio-enthesitis was recommended routinely for screening them regardless of arthritis symptoms, especially in the lower limbs,” the researchers concluded.
Chen ZT, Chen RF, Li XL, et al. The role of ultrasound inn screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis. Eur Radiol. Published online February 28, 2023. https://link.springer.com/article/10.1007/s00330-023-09493-4