title: Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis.
abstract: The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd-5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP] joints, and distal interphalangeal [DIP] joints) and 1st-5th metatarsophalangeal joints of both hands and feet were assessed with US for the presence of synovitis, bone erosions, bone proliferations, and capsular/extracapsular power Doppler signal (only in the PIP joints). The 2nd-5th flexor and extensor tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer. US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high absolute agreement (85% to 100%) for all destructive changes and a more moderate absolute agreement (73% to 100%) for the inflammatory pathologies were found between US and MRI. US detected a higher frequency of DIP joint changes in the PsA patients compared with RA patients. In particular, bone changes were found exclusively in PsA DIP joints. Furthermore, bone proliferations were more common and tenosynovitis was less frequent in PsA than RA. For other pathologies, no disease-specific pattern was observed. US and MRI have major potential for improved examination of joints, tendons, and entheses in fingers and toes of patients with PsA.
authors.affiliation: Department of Rheumatology, University of Copenhagen Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark. charlottewiell@dadlnet.dk
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wiell
authors.forename: Marcin
authors.initials: M
authors.lastname: Szkudlarek
authors.forename: Maria
authors.initials: M
authors.lastname: Hasselquist
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Møller
authors.forename: Aage
authors.initials: A
authors.lastname: Vestergaard
authors.forename: Jesper
authors.initials: J
authors.lastname: Nørregaard
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.forename: Mikkel
authors.initials: M
authors.lastname: Østergaard
mesh_terms: D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging / Q000473:pathology*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011859:Radiography; D013710:Tendons / Q000000981:diagnostic imaging / Q000473:pathology; D014033:Toe Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography