title: Analysis of periarticular bone changes in patients with cutaneous psoriasis without associated psoriatic arthritis.
abstract: OBJECTIVE
  To search for structural bone changes in the joints of psoriasis patients without psoriatic arthritis (PsA).
  
  
  METHODS
  55 psoriasis patients without any current or past symptoms of arthritis or enthesitis and 47 healthy controls were examined by high-resolution peripheral quantitative CT scans of the metacarpophalangeal joints. Number, size and exact localisation of erosions and enthesiophytes were recorded by analysing axial scans of the metacarpal heads and phalangeal bases and were confirmed in additional coronal and/or sagittal sections. In addition, we collected demographic and clinical data including subtype, duration and severity of psoriasis.
  
  
  RESULTS
  Psoriasis patients showed a larger and significantly increased number of enthesiophytes (total number 306; mean±SD/patient 5.62±3.30) compared with healthy controls (total number 138; mean±SD/patient 3.04±1.81, p<0.001). Enthesiophytes were typically found at the dorsal and palmar sides of the metacarpal heads where functional entheses related to extensor and flexor tendons are localised. Bone erosions were rare and not significantly different between psoriasis patients and healthy controls. If present, erosions were almost exclusively found at the radial side of the second metacarpal head in both psoriasis patients and healthy controls.
  
  
  CONCLUSIONS
  Psoriasis patients without PsA show substantial signs of enthesiophyte formation compared with healthy controls. These changes represent new bone formation at mechanically exposed sites of the joint and substantiate the concept of the existence of a 'Deep Koebner Phenomenon' at enthesial sites in psoriasis patients.
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: David
authors: D
authors: Simon
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Francesca
authors: F
authors: Faustini
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Arnd
authors: A
authors: Kleyer
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany Medical Department II, the VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria.
authors: Judith
authors: J
authors: Haschka
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Matthias
authors: M
authors: Englbrecht
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Sebastian
authors: S
authors: Kraus
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Axel J
authors: AJ
authors: Hueber
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany Medical Department II, the VINFORCE Study Group, St. Vincent Hospital, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria.
authors: Roland
authors: R
authors: Kocijan
authors: Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Michael
authors: M
authors: Sticherling
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Georg
authors: G
authors: Schett
authors: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Jürgen
authors: J
authors: Rech
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D050278:Finger Phalanges / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging*; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011565:Psoriasis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: Arthritis; Inflammation; Psoriatic Arthritis