Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy.
Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy.
Clin Exp Rheumatol. 2019 Jul-Aug;37(4):593-599. Epub 2018 Dec 19.
To evaluate the prevalence of articular/extra-articular inflammatory lesions and structural damage on ultrasonography in patients suffering from psoriasis as well as to assess possible correlations between ultrasonographic elementary lesions and clinical features.
Psoriatic patients without musculoskeletal symptoms and healthy controls (HCs) were recruited. All patients received a blinded extended ultrasonographic examination of 42 joints, 12 entheses and 32 tendons. Active synovitis was defined by the presence of a grade ≥2 for grey scale (GS) and ≥1 for power Doppler (PD), while active enthesitis corresponded to entheseal hypoecogenicity in GS and entheseal PD signal (<2 mm from bone insertion).
Forty psoriatic patients and 20 HCs were included. A total of 2516 joints and 712 entheses were scanned. Active synovitis was found in 11/40 (27.5%) psoriatic patients and 0/20 HCs (p=0.01). Articular synovitis (GS≥2) was more frequent in psoriasis than in HCs [34/40 (85.0%) and 11/20 (55.0%) respectively; p=0.024). Active enthesitis was found only in psoriatic patients, with a prevalence of 20.0% (8/40) (p=0.04). No significant difference in the prevalence of tenosynovitis or paratenonitis was observed between psoriatic patients and HCs. In psoriasis cohort, age was correlated with the presence of active synovitis (p=0.03), while male sex and a higher PASI score were independently correlated with the presence of active enthesitis (p=0.05 and p=0.034, respectively).
Active enthesitis and synovitis could be useful to identify subclinical psoriatic arthritis. This might represent a relevant clinical step to better stratify patients with psoriasis.
评估患有银屑病的患者的关节/关节外炎症性病变和结构损伤的超声表现，并评估超声基本病变与临床特征之间的可能相关性。
招募无肌肉骨骼症状的银屑病患者和健康对照者（HCs）。所有患者均接受 42 个关节、12 个附着点和 32 个肌腱的超声扩展检查。通过灰阶（GS）≥2 和功率多普勒（PD）≥1 来定义活跃性滑膜炎，而活跃性附着点炎则对应于 GS 中的附着点低回声和附着点 PD 信号（距骨插入处<2mm）。
共纳入 40 例银屑病患者和 20 例 HCs，共扫描了 2516 个关节和 712 个附着点。11/40（27.5%）例银屑病患者和 0/20 HCs（p=0.01）出现活跃性滑膜炎。关节滑膜炎（GS≥2）在银屑病中比在 HCs 中更为常见[34/40（85.0%）和 11/20（55.0%）；p=0.024]。仅在银屑病患者中发现活跃性附着点炎，其患病率为 20.0%（8/40）（p=0.04）。在银屑病患者和 HCs 之间，未见腱鞘炎或腱旁炎的患病率存在显著差异。在银屑病队列中，年龄与活跃性滑膜炎的存在相关（p=0.03），而男性和更高的 PASI 评分与活跃性附着点炎的存在独立相关（p=0.05 和 p=0.034）。
活跃性附着点炎和滑膜炎可用于识别亚临床银屑病关节炎。这可能是更好地对银屑病患者进行分层的重要临床步骤。
