Skip to main content
SpringerLink
Log in

Bildgebende Verfahren bei Psoriasisarthritis

Imaging modalities in psoriatic arthritis

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

In dem Beitrag werden die verschiedenen bildgebenden Verfahren in der Diagnostik der Psoriasisarthritis (PsA) dargelegt.

Das konventionelle Röntgen wird zur Erfassung der strukturellen Veränderungen an den Gelenken und Sehnenansätzen eingesetzt. Jedoch kommen diese Veränderungen erst sehr spät zur Darstellung, womit dieses Verfahren gerade in der Frühdiagnostik nicht die notwendigen Informationen liefern kann. Jedoch ist durch den Nachweis von Periostproliferationen eine relativ spezifische Diagnose mithilfe des Röntgenbilds möglich.

Die Skeletszintigraphie und Comptertomographie werden insgesamt selten in der Diagnostik der PsA eingesetzt.

Die Gelenksonographie (Ultraschall) gewinnt zunehmend einen größeren Stellenwert in der Frühdiagnostik der entzündlichen Weichteilzeichen an den pripheren Gelenken bei der PsA. So ist die Arthrosonographie in der Lage die Synovitis und Tenosynovitis sowie oberflächlich liegende Erosionen frühzeitg zu detektieren, aber auch die entzündlichen Veränderungen an den Enthesen sind sonographisch gut objektivierbar.

Die Magnetresonanztomographie (MRT) hat ihren Stellenwert in der Abklärung einer möglichen axialen Beteiligung im Rahmen der PsA und ist hier unverzichtbar. Periphere Manifestationen wie Periostitis und Arthritis kommen ebenfalls gut zur Darstellung.

Die hochauflösende Mikro-Computertomographie ist ein neues, interessantes diagnostisches Verfahren, das die Knochenstruktur sehr sensitiv darstellt und damit kleinste Knochenläsionen aufzeigen kann. Typisch für die PsA ist die omegaförmige Erosion und der Nachweis von kleinen coronaförmigen Spikes.

Ein weiteres neues diagnostisches Verfahren ist das fluoreszenzoptische bildgebende Verfahren (FOI) mit dem Xiralite-System, das sehr sensitiv entzündliche Veränderungen an den Händen aufzeigt.

Abstract

This review presents an overview of the range of imaging modalities used in the diagnostic evaluation of patients with psoriatic arthritis (PsA). Conventional radiography is used to detect structural changes of the joints and tendon attachments. These changes occur late in the course of PsA hence conventional radiography contributes little to the early detection of PsA; however, the detection of periosteal proliferations on radiographs allows a relatively specific diagnosis of PsA. Skeletal scintigraphy and computed tomography are rarely used in PsA. Arthrosonography (ultrasound of the joints) is gaining increasing importance in the early identification of inflammatory soft tissue signs of PsA in the peripheral joints. Sonography enables early detection of synovitis and tenosynovitis as well as superficial erosions and also inflammatory processes of the tendon attachments. Magnetic resonance imaging (MRI) is indispensable for identifying possible involvement of the axial skeleton. Moreover, it allows good visualization of periostitis and arthritis. High resolution microcomputed tomography is an interesting novel diagnostic tool which allows highly sensitive evaluation of the bone structure and can detect very tiny bone lesions where typical signs of PsA are omega-shaped erosions and small corona-like spikes. Another interesting new diagnostic technique is fluorescence optical imaging (FOI) with the Xiralite system which is highly sensitive for detecting inflammatory processes of the hands.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11

Literatur

  1. Althoff CE, Appel H, Rudwaleit M et al (2007) Whole-body MRI as a new screening tool for detecting axial and peripheral manifestations of spondyloarthritis. Ann Rheum Dis 66:983–985

    Article  PubMed  CAS  Google Scholar 

  2. Ash ZR, Tinazzi I, Gallego CC et al (2012) Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails. Ann Rheum Dis 71:553–556

    Article  PubMed  Google Scholar 

  3. Aydin SZ, Castillo-Gallego C, Ash ZR et al (2012) Ultrasonographic assessment of nail in psoriatic disease shows a link between onychopathy and distal interphalangeal joint extensor tendon enthesopathy. Dermatology 225:231–235

    Article  PubMed  Google Scholar 

  4. Braum LS, Mcgonagle D, Bruns A et al (2013) Characterisation of hand small joints arthropathy using high-resolution MRI-Limited discrimination between osteoarthritis and psoriatic arthritis. Eur Radiol 23:1686–1693

    Article  PubMed  Google Scholar 

  5. Burghardt AJ, Pialat JB, Kazakia GJ et al (2013) Multicenter precision of cortical and trabecular bone quality measures assessed by high-resolution peripheral quantitative computed tomography. J Bone Miner Res 28:524–536

    Article  PubMed  Google Scholar 

  6. De Agustin JJ, Moragues C, De Miguel E et al (2012) A multicentre study on high-frequency ultrasound evaluation of the skin and joints in patients with psoriatic arthritis treated with infliximab. Clin Exp Rheumatol 30:879–885

    Google Scholar 

  7. De Bucourt M, Scheurig-Munkler C, Feist E et al (2012) Cyst-like lesions in finger joints detected by conventional radiography: comparison with 320-row multidetector computed tomography. Arthritis Rheum 64:1283–1290

    Article  Google Scholar 

  8. Eshed I, Althoff CE, Feist E et al (2008) Magnetic resonance imaging of hindfoot involvement in patients with spondyloarthritides: comparison of low-field and high-field strength units. Eur J Radiol 65:140–147

    Article  PubMed  Google Scholar 

  9. Finzel S, Englbrecht M, Engelke K et al (2011) A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 70:122–127

    Article  PubMed  Google Scholar 

  10. Finzel S, Kraus S, Schmidt S et al (2013) Bone anabolic changes progress in psoriatic arthritis patients despite treatment with methotrexate or tumour necrosis factor inhibitors. Ann Rheum Dis 72:1176–1181

    Article  PubMed  CAS  Google Scholar 

  11. Finzel S, Rech J, Kleyer A (2013) High-resolution peripheral quantitative CT (HR-pQCT). New insights into arthritis. Z Rheumatol 72:129–136

    Article  PubMed  CAS  Google Scholar 

  12. Gladman DD, Antoni C, Mease P et al (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(Suppl 2):ii14–ii17

    Article  PubMed  Google Scholar 

  13. Hermann KG, Althoff CE, Schneider U et al (2005) Magnetic resonance imaging of spinal changes in patients with spondyloarthritis and correlation with conventional radiography. RadioGraphics 25:559–570

    Article  PubMed  Google Scholar 

  14. Hermann KG, Baraliakos X, Van Der Heijde D et al (2012) Descriptions of spinal Magnetic Resonance Imaging (MRI) lesions and definition of a positive MRI of the spine in axial spondyloarthritis (SpA) – a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis 71:1278–1288

    Article  PubMed  Google Scholar 

  15. Hermann KG, Bollow M (2004) Magnetic resonance imaging of the axial skeleton in rheumatoid disease. Best Pract Res Clin Rheumatol 18:881–907

    Article  PubMed  Google Scholar 

  16. Hermann KG, Braun J, Fischer T et al (2004) Magnetic resonance imaging of sacroiliitis: anatomy, histological pathology, MR-morphology, and grading. Radiologe 44:217–228

    Article  PubMed  CAS  Google Scholar 

  17. Hermann KG, Landewe RB, Braun J et al (2005) Magnetic resonance imaging of inflammatory lesions in the spine in ankylosing spondylitis clinical trials: is paramagnetic contrast medium necessary? J Rheumatol 32:2056–2060

    PubMed  Google Scholar 

  18. Kane D, Stafford L, Bresnihan B et al (2003) A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford) 42:1460–1468

    Google Scholar 

  19. Krug R, Burghardt AJ, Majumdar S et al (2010) High-resolution imaging techniques for the assessment of osteoporosis. Radiol Clin North Am 48:601–621

    Article  PubMed  Google Scholar 

  20. Macneil JA, Boyd SK (2007) Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys 29:1096–1105

    Article  PubMed  Google Scholar 

  21. Macneil JA, Boyd SK (2008) Improved reproducibility of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys 30:792–799

    Article  PubMed  Google Scholar 

  22. Marchesoni A, De Lucia O, Rotunno L et al (2012) Entheseal power Doppler ultrasonography: a comparison of psoriatic arthritis and fibromyalgia. J Rheumatol Suppl 89:29–31

    Article  PubMed  Google Scholar 

  23. Mcgonagle D, Lories RJ, Tan AL et al (2007) The concept of a „synovio-entheseal complex“ and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 56:2482–2491

    Article  PubMed  Google Scholar 

  24. Rau R, Wasserberg S, Backhaus M et al (2006) Imaging methods in rheumatology: imaging in psoriasis arthritis (PsA). Z Rheumatol 65:159–167

    Article  PubMed  CAS  Google Scholar 

  25. Raza N, Hameed A, Ali MK (2008) Detection of subclinical joint involvement in psoriasis with bone scintigraphy and its response to oral methotrexate. Clin Exp Dermatol 33:70–73

    Article  PubMed  CAS  Google Scholar 

  26. Rudwaleit M, Jurik AG, Hermann KG et al (2009) Defining active sacroiliitis on Magnetic Resonance Imaging (MRI) for classification of axial spondyloarthritis – a consensual approach by the ASAS/OMERACT MRI Group. Ann Rheum Dis 68:1520–1527

    Article  PubMed  CAS  Google Scholar 

  27. Savnik A, Malmskov H, Thomsen HS et al (2001) MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T). Eur Radiol 11:1030–1038

    Article  PubMed  CAS  Google Scholar 

  28. Schirmer C, Scheel AK, Althoff CE et al (2007) Diagnostic quality and scoring of synovitis, tenosynovitis and erosions in low-field MRI of patients with rheumatoid arthritis: a comparison with conventional MRI. Ann Rheum Dis 66:522–529

    Article  PubMed  Google Scholar 

  29. Stach CM, Bauerle M, Englbrecht M et al (2010) Periarticular bone structure in rheumatoid arthritis patients and healthy individuals assessed by high-resolution computed tomography. Arthritis Rheum 62:330–339

    PubMed  Google Scholar 

  30. Taylor W, Gladman D, Helliwell P et al (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673

    Article  PubMed  Google Scholar 

  31. Werner SG, Langer HE, Ohrndorf S et al (2012) Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology. Ann Rheum Dis 71:504–510

    Article  PubMed  Google Scholar 

  32. Werner SG, Spiecker F, Mettler S et al (2013) ICG-enhanced fluorescence optical imaging (FOI) detects typical inflammatory changes in subjects with arthralgia and psoriasis. Ann Rheum Dis 72(Suppl 3):759

    Google Scholar 

  33. Zachariae H (2003) Prevalence of joint disease in patients with psoriasis: implications for therapy. Am J Clin Dermatol 4:441–447

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. K.-G.A. Hermann, S. Ohrndorf, und S. Finzel geben an, dass kein Interessenkonflikt besteht. S.G. Werner und M. Backhaus geben folgende Beziehungen an: Die Charité – Universitätsmedizin Berlin wurde für die Durchführung von FOI-Studien durch Pfizer unterstützt. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Institut für Radiologie, Charité – Universitätsmedizin Berlin, Universitätsklinikum Charité – Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    K.-G.A. Hermann

  2. Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    S. Ohrndorf, S.G. Werner & M. Backhaus

  3. RHIO – Rheumatologie, Immunologie, Osteologie Zentrum, Düsseldorf, Deutschland

    S.G. Werner

  4. Medizinische Klinik 3 – Rheumatologie und Immunologie, Universitätsklinikum Erlangen-Nürnberg, Erlangen, Deutschland

    S. Finzel

Authors
  1. K.-G.A. Hermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Ohrndorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S.G. Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Finzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Backhaus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K.-G.A. Hermann.

Additional information

Kay-Geert A. Hermann und Sarah Ohrndorf haben zu gleichen Teilen zum Artikel beigetragen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hermann, KG., Ohrndorf, S., Werner, S. et al. Bildgebende Verfahren bei Psoriasisarthritis. Z. Rheumatol. 72, 771–778 (2013). https://doi.org/10.1007/s00393-013-1188-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-013-1188-8

Schlüsselwörter

Keywords

Search

Navigation