超声在筛查中重度银屑病患者亚临床银屑病关节炎中的作用。

The role of ultrasound in screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis.

机构信息

Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.

Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.

出版信息

Eur Radiol. 2023 Jun;33(6):3943-3953. doi: 10.1007/s00330-023-09493-4. Epub 2023 Feb 28.

DOI:10.1007/s00330-023-09493-4

PMID:36853346

Abstract

OBJECTIVE

To identify patients in the subclinical psoriatic arthritis (Sub-PsA) phase by ultrasound (US) and provide a solution to screen them.

METHODS

A total of 490 participants with moderate-to-severe psoriasis were evaluated. Among them, 384 participants without arthritis symptoms were enrolled into the silent psoriasis group and 106 participants with arthritis symptoms, called prodromal/active PsA phase, were enrolled into the clinical PsA group. Another 80 non-psoriasis participants were enrolled into the control group. Each participant received clinical assessments and US examinations of 60 joints, 38 tendons, and 40 entheses. We compared the incidences of synovio-enthesitis, synovitis, tenosynovitis, erosion, and dactylitis detected on US among the three groups. Subsequently, on the basis of significant US findings, we distinguished Sub-PsA from psoriasis alone (PsO) in the silent psoriasis group and analyzed the clinical characteristics, mainly including basic clinical characteristics, body surface area (BSA), and Psoriasis Area and Severity Index (PASI) score.

RESULTS

Only synovio-enthesitis significantly differed between the control group and the silent psoriasis group (1.3% vs. 16.1%, p < 0.001). The knee was the most commonly involved site of synovio-enthesitis (79.0%). Taking synovio-enthesitis as the standard, 16.1% of silent psoriasis participants and 12.7% of all psoriasis participants were in the Sub-PsA phase. Furthermore, there were no differences in BSA and PASI among the three phases of PsO, Sub-PsA, and prodromal/active PsA.

CONCLUSIONS

Since the psoriasis patients in Sub-PsA phase was as high as 12.7% in all patients with moderate-to-severe psoriasis, US-detected synovio-enthesitis was recommended routinely for screening them regardless of arthritis symptoms, especially in the lower limbs.

KEY POINTS

• Synovio-enthesitis on ultrasound was significantly associated with subclinical psoriatic arthritis, especially in the lower limbs. • Routine ultrasound evaluation could help screen psoriasis patients in the subclinical psoriatic arthritis phase, which was as high as 12.7% in all psoriasis patients.

摘要

目的

通过超声（US）识别亚临床银屑病关节炎（Sub-PsA）患者，并提供一种筛查方法。

方法

共评估了 490 名中重度银屑病患者。其中，384 名无关节炎症状的患者被纳入沉默性银屑病组，106 名有关节炎症状的患者被纳入临床 PsA 组。另外 80 名非银屑病患者被纳入对照组。每位患者均接受临床评估和 60 个关节、38 个肌腱和 40 个肌腱附着点的 US 检查。我们比较了三组间 US 检测到的滑膜炎、肌腱炎、腱鞘炎、侵蚀和指炎的发生率。随后，基于有意义的 US 发现，我们将沉默性银屑病组中的 Sub-PsA 与单纯银屑病（PsO）区分开来，并分析了临床特征，主要包括基本临床特征、体表面积（BSA）和银屑病面积和严重程度指数（PASI）评分。

结果

仅在对照组和沉默性银屑病组之间，滑膜炎-肌腱炎显著不同（1.3%对 16.1%，p<0.001）。膝关节是滑膜炎-肌腱炎最常见的受累部位（79.0%）。以滑膜炎-肌腱炎为标准，16.1%的沉默性银屑病患者和 12.7%的所有银屑病患者处于 Sub-PsA 期。此外，在 PsO、Sub-PsA 和前驱/活动期 PsA 三个阶段，BSA 和 PASI 无差异。