title: Subclinical joint inflammation in patients with psoriasis without concomitant psoriatic arthritis: a cross-sectional and longitudinal analysis.
abstract: OBJECTIVE
  To search for subclinical inflammatory joint disease in patients with psoriasis without psoriatic arthritis (PsA), and to determine whether such changes are associated with the later development of PsA.
  
  
  METHODS
  Eighty-five subjects without arthritis (55 with psoriasis and 30 healthy controls) received high field MRI of the hand. MRI scans were scored for synovitis, osteitis, tenosynovitis and periarticular inflammation according to the PsAMRIS method. Patients with psoriasis additionally received complete clinical investigation, high-resolution peripheral quantitative CT for detecting erosions and enthesiophytes and were followed up for at least 1 year for the development of PsA.
  
  
  RESULTS
  47% of patients with psoriasis showed at least one inflammatory lesion on MRI. Synovitis was the most prevalent inflammatory lesion (38%), while osteitis (11%), tenosynovitis (4%) and periarticular inflammation (4%) were less frequent. The mean (±SD) PsAMRIS synovitis score was 3.0±2.5 units. Enthesiophytes and bone erosions were not different between patients with psoriasis with or without inflammatory MRI changes. The risk for developing PsA was as high as 60% if patients had subclinical synovitis and symptoms related to arthralgia, but only 13% if patients had normal MRIs and did not report arthralgia.
  
  
  CONCLUSIONS
  Prevalence of subclinical inflammatory lesions is high in patients with cutaneous psoriasis. Arthralgia in conjunction with MRI synovitis constitutes a high-risk constellation for the development of PsA.
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.|Clinic of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Francesca
authors.initials: F
authors.lastname: Faustini
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Simon
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Oliveira
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Arnd
authors.initials: A
authors.lastname: Kleyer
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.|Medical Department II, St. Vincent Hospital, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Haschka
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Englbrecht
authors.affiliation: CSD Clinica Som Diagnosticos, Belém, Pará, Brazil.
authors.forename: Alan Rodrigues
authors.initials: AR
authors.lastname: Cavalcante
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kraus
authors.affiliation: CSD Clinica Som Diagnosticos, Belém, Pará, Brazil.
authors.forename: Taiane Ponte
authors.initials: TP
authors.lastname: Tabosa
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Camille
authors.initials: C
authors.lastname: Figueiredo
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Hueber
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.|Medical Department II, St. Vincent Hospital, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria.
authors.forename: Roland
authors.initials: R
authors.lastname: Kocijan
authors.affiliation: Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cavallaro
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
authors.affiliation: Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Sticherling
authors.affiliation: Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rech
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000150:complications / Q000000981:diagnostic imaging; D001168:Arthritis / Q000150:complications / Q000000981:diagnostic imaging*; D015535:Arthritis, Psoriatic / Q000209:etiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000000981:diagnostic imaging*; D012307:Risk Factors; D012720:Severity of Illness Index; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging*
keywords: Magnetic Resonance Imaging; Psoriatic Arthritis; Synovitis