title: Achilles tendon ultrasonography may detect early features of psoriatic arthropathy in patients with cutaneous psoriasis.
abstract: BACKGROUND
  Psoriatic arthropathy is a progressive and debilitating disease involving reduction of functional activity of the articulations with consequent deterioration of the patient's quality of life. The entheses represent the initial site of articular inflammation and the enthesis of the Achilles tendon is the first to be affected. In some patients with psoriasis, enthesitis may not be diagnosed because it is still asymptomatic.
  
  
  OBJECTIVE
  To evaluate whether ultrasonography allows early diagnosis in a larger population and to identify significant alterations of enthesitis beyond increased thickness of the Achilles tendon.
  
  
  METHODS
  The study was undertaken on 59 patients (16 women, 43 men), with chronic plaque psoriasis and 59 patients with other dermopathies. The patients underwent echographic evaluation of the Achilles heel using a Voluson imaging system. The severity of the psoriasis was evaluated by the Psoriasis Area Severity Index and the enthesitis by the Glasgow Ultrasound Enthesitis Scoring System (GUESS).
  
  
  RESULTS
  The GUESS score was higher in those patients with psoriasis compared with patients with other dermopathies. Among psoriatic patients, 22% (13 of 59) presented tendon thickness over 5·29 mm and irregular tendon structure. Other abnormalities affected the tendon in 12 patients. In seven patients (12%) bursitis was also revealed.
  
  
  CONCLUSIONS
  Our data confirm that ultrasonography is a sensitive technique which reveals enthesitis more frequently than clinical examination in patients affected by psoriasis. We suggest the use of ultrasonography of the Achilles tendon in early diagnosis of psoriatic arthropathy with the objective of preventing progression of the pathology.
authors.affiliation: Department of Dermatology, University of Palermo, Via Del Vespro n., 131-90127, Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pistone
authors.forename: M
authors.initials: M
authors.lastname: La Vecchia
authors.forename: A
authors.initials: A
authors.lastname: Pistone
authors.forename: M R
authors.initials: MR
authors.lastname: Bongiorno
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000000981:diagnostic imaging; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000000981:diagnostic imaging*; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult