Boussaid Soumaya, Ben Aissa Rania, Rekik Sonia, Rahmouni Safa, Jammali Samia, Zouaoui Khaoula, Sahli Hela, Elleuch Mohamed
Rheumatology Department, Rabta Hospital, Tunis, Tunisia.
Faculty of Medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.
Mediterr J Rheumatol. 2023 Sep 18;34(4):495-505. doi: 10.31138/mjr.180923.ues. eCollection 2023 Dec.
The clinical screening of enthesitis and synovitis in patients with psoriasis lacks specificity and sensitivity during the preclinical phase.
to assess US subclinical synovitis and enthesitis in psoriatic patients compared with healthy controls.
A cross-sectional study on 40 psoriatic patients and 40 healthy sex- and age-matched controls. US examination of 18 joints was performed along with 22 entheseal sites on the upper and lower limbs. US subscores were established according to the US abnormalities: inflammatory score (tendon thickening, hypoechogenicity, bursitis, Doppler signal), damage score (calcification, enthesophytes, bone erosion) and total score (the sum of inflammatory and damage scores).
US synovitis were more frequent in psoriatic patients (0.68%) than in controls (0.29%), but the difference was not significant. Patients with psoriasis had more US enthesitis (92,5%) compared to controls (40%)(p<0.001). The total number of enthesitis was higher in the psoriatic group (20.90%) compared to controls (4,78%)(p<0.001). There were more US abnormalities in the psoriatic group compared to controls for calcaneal tendon enthesis(p<0.001), distal patellar tendon enthesis(p<0.001) and deep flexor tendons of the finger enthesis(p<0.001). Compared to controls, psoriatic patients had a significantly higher inflammatory score (Mean±SD) (2.85±3.34 versus 0.58±1.17), damage score (3±2.57 versus 0.60±1.41), and total score (5.85±5.20 versus 1.18±2.07) (p < 0.001 each). Patients with scalp psoriasis had more US enthesitis (p=0.020).
Our results indicate that US enthesitis and synovitis are more frequent in patients with psoriasis. Prospective studies with larger sample size are needed to define the contribution of US in predicting the clinical onset of PsA.
银屑病患者中附着点炎和滑膜炎的临床筛查在临床前期缺乏特异性和敏感性。
与健康对照相比，评估银屑病患者的超声亚临床滑膜炎和附着点炎。
对40例银屑病患者和40例年龄及性别匹配的健康对照进行横断面研究。对18个关节以及上下肢的22个附着点部位进行超声检查。根据超声异常情况建立超声子评分：炎症评分（肌腱增厚、低回声、滑囊炎、多普勒信号）、损伤评分（钙化、骨赘、骨质侵蚀）和总分（炎症评分与损伤评分之和）。
银屑病患者的超声滑膜炎发生率（0.68%）高于对照组（0.29%），但差异无统计学意义。与对照组（40%）相比，银屑病患者的超声附着点炎发生率更高（92.5%）（p<0.001）。银屑病组的附着点炎总数（20.90%）高于对照组（4.78%）（p<0.001）。与对照组相比，银屑病组在跟腱附着点（p<0.001）、髌腱远端附着点（p<0.001）和手指屈肌腱深层附着点（p<0.001）的超声异常更多。与对照组相比，银屑病患者的炎症评分（均值±标准差）显著更高（2.85±3.34对0.58±1.17）、损伤评分（3±2.57对0.60±1.41）和总分（5.85±5.20对1.18±2.07）（每项p<0.001）。头皮银屑病患者的超声附着点炎更多（p=0.020）。
我们的结果表明，银屑病患者的超声附着点炎和滑膜炎更为常见。需要进行更大样本量的前瞻性研究来确定超声在预测银屑病关节炎临床发病中的作用。
