Sun Xiaoying, Geng Yan, Song Zhibo, Deng Xuerong, Hu Xinyi, Wang Yu, Zhang Xiaohui, Zhao Juan, Li Guangtao, Ji Lanlan, Xie Wenhui, Huang Hong, Zhang Zhuoli
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
Front Immunol. 2025 May 30;16:1562996. doi: 10.3389/fimmu.2025.1562996. eCollection 2025.
Psoriatic arthritis (PsA) is a complex and varied inflammatory condition that can cause arthritis, enthesitis, dactylitis, and spondylitis. In recent years, ultrasound (US) imaging has emerged as a valuable adjunct to physical examination (PE) in the assessment of PsA. This study aims to assess the concordance between clinical manifestations of swelling/tenderness and US-detected inflammatory lesions in the wrists and hands of patients with PsA.
The study utilized the PKUPsA cohort and included both clinical and US evaluations of 30 joints per PsA patient, encompassing bilateral wrists, proximal interphalangeal (PIP), metacarpophalangeal (MCP), and distal interphalangeal (DIP) joints. Clinical assessments included the detection of tenderness or swelling, while US evaluations identified synovitis, tenosynovitis/paratenonitis, enthesitis, and soft tissue inflammation. Cohen's kappa (κ) statistic was employed to measure the concordance between clinical and sonographic findings.
A total of 188 patients with PsA were included in the study. US-detected inflammatory lesions were more common in swollen joints than tender joints (50.6% vs. 40.3%, p<0.01). The overall concordance between clinical findings and US-detected inflammatory lesions was found to be moderate (κ=0.448, p<0.01). Joint swelling showed a higher level of concordance with US-detected inflammation (κ=0.497, p<0.01) than tenderness (κ=0.406, p<0.01). In the MCPs and wrists, synovitis exhibited a higher concordance with PE than tenosynovitis/paratenonitis. In contrast, in most PIP joints, US-detected tenosynovitis/paratenonitis aligned more closely with PE than synovitis. In DIP joints, enthesitis showed a greater concordance with PE than both synovitis and tenosynovitis/paratenonitis.
Ultrasound-detected inflammatory lesions in PsA patients showed a moderate level of concordance with PE in PsA patients, but significant discrepancies were observed across different joints and lesion types. These findings highlight the importance of incorporating US into the routine management for a more comprehensive understanding of PsA.
银屑病关节炎（PsA）是一种复杂多样的炎症性疾病，可导致关节炎、附着点炎、指（趾）炎和脊柱炎。近年来，超声（US）成像已成为银屑病关节炎评估中体格检查（PE）的重要辅助手段。本研究旨在评估银屑病关节炎患者手腕和手部肿胀/压痛的临床表现与超声检测到的炎症性病变之间的一致性。
本研究采用PKUPsA队列，对每位银屑病关节炎患者的30个关节进行临床和超声评估，包括双侧手腕、近端指间关节（PIP）、掌指关节（MCP）和远端指间关节（DIP）。临床评估包括压痛或肿胀的检测，而超声评估则识别滑膜炎、腱鞘炎/腱周组织炎、附着点炎和软组织炎症。采用Cohen's kappa（κ）统计量来衡量临床和超声检查结果之间的一致性。
本研究共纳入188例银屑病关节炎患者。超声检测到的炎症性病变在肿胀关节中比压痛关节中更常见（50.6%对40.3%，p<0.01）。临床检查结果与超声检测到的炎症性病变之间的总体一致性为中等（κ=0.448，p<0.01）。关节肿胀与超声检测到的炎症的一致性水平（κ=0.497，p<0.01）高于压痛（κ=0.406，p<0.01）。在掌指关节和手腕中，滑膜炎与体格检查的一致性高于腱鞘炎/腱周组织炎。相反，在大多数近端指间关节中，超声检测到的腱鞘炎/腱周组织炎与体格检查的一致性比滑膜炎更高。在远端指间关节中，附着点炎与体格检查的一致性高于滑膜炎和腱鞘炎/腱周组织炎。
银屑病关节炎患者超声检测到的炎症性病变与体格检查的一致性为中等水平，但在不同关节和病变类型中存在显著差异。这些发现强调了将超声纳入常规管理以更全面了解银屑病关节炎的重要性。
