Graceffa Dario, Bonifati Claudio, Lora Viviana, Saraceni Pier Luigi, De Felice Catia, Chimenti Maria Sole, Perricone Roberto, Morrone Aldo
Department of Clinical Dermatology, San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
Department of "Medicina dei Sistemi", Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Viale Oxford, 81, 00100 Rome, Italy.
Indian J Dermatol Venereol Leprol. 2019 Mar-Apr;85(2):175-181. doi: 10.4103/ijdvl.IJDVL_205_17.
The inflammatory involvement of the enthesis in the course of psoriasis is accompanied by structural abnormalities detectable by ultrasound. The most common of these abnormalities is the thickening of the tendon at the insertion site.
The aim of the present study was to compare the thickness of entheses of patients with psoriatic arthritis, only skin psoriasis, and healthy controls.
A cross-sectional study was conducted in a cohort of patients affected with either only skin psoriasis or psoriatic arthritis as well as in a control group. Eight entheses sites were scanned by ultrasound bilaterally. The following entheseal characteristics were collected and recorded in a predefined database: entheseal thickness, bone erosions, enthesis calcifications (enthesophytes), presence of blood flow, and presence of bursitis. All the detected entheseal changes were scored, and the data was statistically analyzed.
The major differences in enthesis thickness between only skin psoriasis and psoriatic arthritis patients were found at the following sites: (i) olecranon tuberosity, (ii) superior pole of the patella, and (iii) medial epicondyle of femur. The thickness of the medial collateral ligament at the site of the femoral origin was increased in psoriatic arthritis, but not in both only skin psoriasis and healthy controls. The score obtained by adding the thickness of all the 8 examined entheses for each patient showed significant differences among the three groups (psoriatic arthritis: 81.3; only skin psoriasis 74.4; Controls: 67.6; P < 0.0001). Interestingly, we found that in psoriatic arthritis patients, the highest enthesis thickening was seen in entheses affected by bone erosions.
The small sample of patients studied is a limiting factor in this study.
Our data demonstrated that the ultrasound measurement of the enthesis thickness enables a distinction between patients with psoriatic arthritis from those with only skin psoriasis. It is a useful method to improve diagnostic accuracy, especially in patients without clear clinical signs of enthesitis.
银屑病病程中附着点的炎症累及伴有超声可检测到的结构异常。这些异常中最常见的是附着点处肌腱增厚。
本研究的目的是比较银屑病关节炎患者、仅患皮肤银屑病患者和健康对照者的附着点厚度。
对一组仅患皮肤银屑病或银屑病关节炎的患者以及一个对照组进行了横断面研究。双侧对八个附着点部位进行超声扫描。在一个预定义的数据库中收集并记录以下附着点特征：附着点厚度、骨侵蚀、附着点钙化（骨赘）、血流情况和滑囊炎的存在。对所有检测到的附着点变化进行评分，并对数据进行统计分析。
仅患皮肤银屑病患者和银屑病关节炎患者在附着点厚度上的主要差异见于以下部位：（i）尺骨鹰嘴结节，（ii）髌骨上极以及（iii）股骨内上髁。银屑病关节炎患者股骨起点处的内侧副韧带厚度增加，而仅患皮肤银屑病患者和健康对照者均未出现这种情况。为每位患者所有8个检查附着点的厚度相加所得的分数在三组之间显示出显著差异（银屑病关节炎：81.3；仅患皮肤银屑病：74.4；对照组：67.6；P<0.0001）。有趣的是，我们发现银屑病关节炎患者中，骨侵蚀累及的附着点增厚最为明显。
本研究中患者样本量较小是一个限制因素。
我们的数据表明，超声测量附着点厚度能够区分银屑病关节炎患者和仅患皮肤银屑病患者。这是一种提高诊断准确性的有用方法，尤其适用于没有明显附着点炎临床体征的患者。
