Psoriatic arthritisSubclinical Entheseal Involvement in Patients with Psoriasis: An Ultrasound Study
Section snippets
Patients
A total of 47 patients were referred from the dermatologist with a definite diagnosis of psoriasis to be included in the study. Two patients were excluded since tenderness was found by the rheumatologist at the Achilles enthesis.
The study was conducted on 45 patients with psoriasis and 45 healthy sex- and age-matched controls, recruited from January 2008 to February 2009. The body mass index (BMI) median; CI 95% for the median; SD were as follows: 24.2; 22.6 to 24.9; 3.66 for psoriatic
Results
A total of 450 entheseal sites in 45 patients with psoriasis were examined by US. In 148 of 450 (32.9%) entheseal sites, grayscale US found at least 1 sign indicative of enthesopathy. The entheseal site with the highest number of signs of enthesopathy was the Achilles enthesis (43/450) (9.5%), followed by distal patellar enthesis (41/450) (9.1%), proximal patellar enthesis (31/450) (6.9%), quadriceps enthesis (29/450) (6.4%), and plantar aponeurosis enthesis (4/450) (0.9%). In 4/450 (0.9%)
Discussion
Enthesitis has been indicated as a distinctive pathologic condition affecting patients with PsA (20). Because radiographs are not sensitive enough for the detection of early signs of entheseal involvement (8, 9, 21, 22), US may be considered as an alternative imaging technique in the diagnosis of enthesopathy (21, 22, 23).
High-resolution US has been shown to be of value in revealing subclinical joint and tendon inflammation in patients with chronic arthritis (24, 25). Its sensitivity in the
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The authors have no conflicts of interest to disclose.