MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis

Coates, Laura C.; Hodgson, Richard; Conaghan, Philip G.; Freeston, Jane

doi:10.1016/j.berh.2012.09.004

Cited by 82 publications

(107 citation statements)

References 71 publications

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“…In parallel, advanced imaging techniques, such as MRI and MSUS, have been increasingly used in the diagnosis and monitoring of the outcomes of patients with PsA [37]. Although MSUS is less sensitive than MRI, it is more widely available and economical for the evaluation of tendons [38].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of enthesis thickening in psoriatic arthritis patients treated with adalimumab compared to methotrexate

et al. 2014

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The objective of the study was to combine ultrasonographic (US) with clinical findings for comparing the effect of adalimumab (ADA) to methotrexate (MTX) on the thickness of tendons and enthesis in psoriatic arthritis (PsA) patients. Forty-three consecutive PsA patients were examined at baseline and after 6 and 12 weeks of treatment with ADA or MTX. The US assessment included thickness measurement of the extensor (ET) and flexor tendons (FT) of the second and third finger of both hands, plantar aponeurosis (PA) and the Achilles tendon (AT) bilaterally. Disease activity (DA) was assessed by the number of tender (TJ) and swollen joints (SJ), the number of inflamed enthesis (IE), pain assessment (PAI), and patient (PDAI) and physician (PHDAI) disease activity evaluations by visual activity score (VAS). Nineteen patients received MTX and 24 patients received ADA. All DA parameters improved in both groups. A decrease in thickness of tendons and enthesis was observed only in the ADA group, reaching a level of significance for the left AT (p = 0.01), left PA (p = 0.007), the second left FT (p = 0.04) and the third ET (p = 0.04). ADA patients showed a trend towards a better response to treatment compared to MTX patients that reach significance at week 6 of treatment for the thickness of left AT (p = 0.04), left PA (p = 0.03), the number of TJ (p = 0.0136), PAI (p = 0.0028), and PDAI (p = 0.029). ADA treatment for PsA compared to MTX significantly improved signs of DA and several US parameters. US assessment of enthesis can be an additional useful tool in the monitoring of psoriatic enthesopathy.

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Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of enthesis thickening in psoriatic arthritis patients treated with adalimumab compared to methotrexate

et al. 2014

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“…Additionally both scores correlated similarly with US findings. The poor association between PD and enthesitis scores in our study might be explained by the fact that there are fewer vessels in inflamed enthesis compared with synovium making it harder to visualize 22,23 . US examinations was assessed in positions previously described 12 but not fully relaxed positions, and this may also contribute to reduction of the sensitivity of PD [24][25][26][27] .…”

Section: Before Instruction After Instructionmentioning

confidence: 50%

Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound

Kristensen

Christensen

Schmidt

et al. 2016

MLTJ

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SummaryBackground: Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability. Objective: To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clinical examination for the detection of entheseal abnormalities. Methods: 20 rheumatologists performed repeated assessment of enthesitis in patients with established psoriatic arthritis before and after a 2-hour training session in standardised enthesitis count according to Leeds 5 . LEI has been developed for measuring enthesitis in patients with PsA 6 . However, all the scoring systems are known to have limitations in terms of reliability, validity, and sensitivity 3 . Another limitation of clinical enthesitis count is the specificity of the finding of tenderness in these areas. Many of the entheseal points are relatively near to joints and accepted tender points for fibromyalgia, raising the possibility of misclassification. Imaging modalities such as ultrasound (US) have been investigated to determine whether they improve entheseal disease assessment. Studies have shown that US indices for enthesitis are more sensitive than clinical examination 7,8 . The OMERACT US Specialist Interest Group has achieved agreement on US definition of enthesitis and its elementary components to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work 9 . However, the value of US findings at the enthesis is not investigated fully. Although Doppler sign at the enthesis is found more frequently in patients with PsA, as compared to healthy controls 10 , it can also be seen in patients with rheumatoid arthritis 11 . Bone changes such as enthesophytes and erosions may also be found as degenerative changes in weight-bearing entheses 12 . Furthermore, the application of US in daily practice in patients with PsA is limited by the time required to examine multiple sites of enthesitis. Since clinical enthesitis is a hallmark feature of PsA, there is a need for improvement of clinical assessment of enthesitis and evaluation of the benefits of US as an outcome measure in daily practice. The aim of this study was to examine if training in standardised assessment of enthesitis according to LEI and SPARCC is able to improve interobserver variation in patients with established PsA. Furthermore, we aimed to compare US and clinical assessment of enthesitis to determine the added value of US in enthesitis assessment. Methods SubjectsOutpatients with PsA according to Classification Criteria for Psoriatic Arthritis (CASPAR criteria) were enrolled from the Departments of Rheumatology, Aalborg University Hospital, Denmark, during routine presentation to the clinic. The inclusion criteria were established PsA requiring systemic treatment with disease modifying anti-rheumatic drugs. Exclusion criteria were treatment with biological drugs or treatment with oral corticosteroids. All patients taking NSAID...

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“…Sensitive imaging techniques such as MRI and US are being used more frequently to assess the extent, variability, differences and distribution of inflammation in various rheumatological conditions such as RA and psoriatic arthritis (18). While the present study is limited by the sample size, these imaging techniques have proved helpful in characterising the inflammatory disease process in CFA.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound and magnetic resonance imaging assessment of joint disease in symptomatic patients with cystic fibrosis arthropathy

Fitch

Williams

Freeston

et al. 2016

Journal of Cystic Fibrosis

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MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis

Cited by 82 publications

References 71 publications

Ultrasound assessment of enthesis thickening in psoriatic arthritis patients treated with adalimumab compared to methotrexate

Ultrasound assessment of enthesis thickening in psoriatic arthritis patients treated with adalimumab compared to methotrexate

Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound

Ultrasound and magnetic resonance imaging assessment of joint disease in symptomatic patients with cystic fibrosis arthropathy

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