Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study

Abstract

Background: Psoriasis is associated with a form of spondyloarthropathy in 10-30% of cases. A major feature of psoriatic arthritis is enthesitis. In some patients with psoriasis the presence of enthesitis could be underdiagnosed. Objective: To investigate the presence of lower limbs entheseal abnormalities in patients with chronic plaque psoriasis without signs and symptoms of psoriatic arthritis. Methods: Thirty patients with psoriasis and 30 controls underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Results: Mean GUESS score was significantly higher in patients with psoriasis as compared with controls: 7.9 (0.6) vs 2.9 (0.3); p,0.0001. In particular, the thickness of all tendons examined was significant higher in cases than in controls (p,0.0001), as well as the number of enthesophytes in all sites examined. In both cases and controls, the GUESS score was directly correlated with age (r = 0.22; p = 0.008), body mass index (r = 0.23, p = 0.0067) and waist circumference (r = 0.17; p = 0.02). In contrast, the GUESS score was not correlated with the duration and severity of psoriasis according to the Psoriasis Area and Severity Index (r = 0.03; p = 0.8) and body surface area involvement (r = 0.07; p = 0.6). Conclusions: Entheseal abnormalities can be documented by ultrasonography in clinically asymptomatic patients with psoriasis. These findings could be related to a subclinical entheseal psoriatic inflammation. We suggest close follow-up of patients with psoriasis with entheseal abnormalities for early diagnosis of psoriatic arthritis.

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound

“…Gisondi et al have used ultrasound to assess entheses in psoriasis patients, showing a significantly higher mean GUESS score compared to controls with other types of skin disease (14). Scarpa et al examined early PsA subjects (with and without psoriasis) with articular and/or entheseal involvement of 12 weeks or less duration and showed that bone scintigraphy identifies 3 times as many affected areas as CE.…”

Preliminary Evidence That Subclinical Enthesopathy May Predict Psoriatic Arthritis in Patients with Psoriasis

“…Of the 30 patients originally evaluated 5 , 28 returned for a re-evaluation. No patient received systemic treatment with a disease-modifying antirheumatic drug.…”

“…We previously used ultrasound (US) to show a high frequency of subclinical entheseal involvement in patients presenting with psoriasis but without clinically evident arthritis 5 . We investigated whether subclinical enthesopathy in patients with psoriasis predicted the future development of PsA.…”

“…Once again the sonographer was blinded to the patient's clinical status or joint symptoms and was unaware of the original US scan findings. On followup imaging, ultrasonography was performed using a LOGIQ 5 instrument (GE Healthcare) with a 10-15 MHz probe, whereas an ALT HDI3000 machine with a 10-15 MHz linear probe was used in the baseline assessment 5 . On followup imaging, the power-Doppler settings were standardized, with a pulse repetition frequency of 750 Hz, a color-mode frequency of 9.1 MHz, and low-wall filters.…”

The Sound of Enthesis

“…The most impressive aspect of US in the assessment of enthesopathy is the wide range of both grayscale and power Doppler (PD) patterns even in patients with early or subclinical disease 13,14 .…”