Drude Benedict, Maugesten Øystein, Werner Stephanie G, Klotsche Jens, Burmester Gerd-Rüdiger, Krönke Gerhard, Backhaus Marina, Berger Jörn, Haugen Ida Kristin, Ohrndorf Sarah
Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway.
Front Med (Lausanne). 2025 Aug 15;12:1581265. doi: 10.3389/fmed.2025.1581265. eCollection 2025.
Fluorescence optical imaging (FOI) visualizes enhanced microcirculation in the hands as a marker for inflammation. The correct diagnosis of psoriatic arthritis (PsA) and erosive hand osteoarthritis (EHOA) can be challenging. The aim of this study was to differentiate active PsA from EHOA using FOI.
An atlas with FOI images of different grades of enhancement (FOIAS 0-3) and typical morphologic patterns ('Streaky signals', 'Green/Blue Nail sign', 'Werner sign', and 'Bishop's crozier sign') for PsA and hand EHOA was created. Twenty FOI sequences of patients with PsA and EHOA were randomly mixed and scored by two blinded readers. All images were scored twice by one of the two readers. Inter- and intra-reader reliability for joint enhancement, morphologic patterns and diagnosis (PsA vs. EHOA) was calculated. Subsequently, one reader blinded to the diagnosis scored the remaining PsA ( = 54) and EHOA ( = 47) images using the same atlas.
Inter-reader reliability on joint enhancement was overall substantial ( = 0.74), with substantial to almost perfect intra-reader reliability ( = 0.88). Inter-reader reliability on all morphological patterns was fair ( = 0.36) and substantial ( = 0.68) in the intra-reader exercise with variation between the different patterns. Inter- ( = 0.3) and intra-reader reliability ( = 0.4) on diagnosis was fair. In analyses of all 101 cases (47 EHOA, 54 PsA), persons with EHOA presented significantly higher mean FOI sum scores in the PIP (38.98 vs. 20.00) and DIP joints (16.45 vs. 8.40) compared to the PsA patients. Regarding morphology, the 'Werner sign' was significantly more often detected in PsA than in EHOA (55.6% vs. 21.3%; < 0.01).
Joint enhancement in FOI can be reliably assessed using a predefined scoring method. The stronger enhancement in PIP and DIP joints for EHOA cases and the occurrence of 'Werner sign' in PsA cases may facilitate the differential diagnosis between the two diagnoses.
荧光光学成像（FOI）可将手部增强的微循环可视化，作为炎症的标志物。银屑病关节炎（PsA）和侵蚀性手部骨关节炎（EHOA）的正确诊断可能具有挑战性。本研究的目的是使用FOI区分活动性PsA和EHOA。
创建了一个图谱，其中包含不同增强等级（FOIAS 0 - 3）的FOI图像以及PsA和手部EHOA的典型形态学模式（“条纹信号”、“绿/蓝甲征”、“维尔纳征”和“主教权杖征”）。将20例PsA和EHOA患者的FOI序列随机混合，由两名不知情的读者进行评分。所有图像由两名读者之一进行两次评分。计算读者间和读者内关于关节增强、形态学模式和诊断（PsA与EHOA）的可靠性。随后，一名对诊断不知情的读者使用同一图谱对其余的PsA（n = 54）和EHOA（n = 47）图像进行评分。
读者间关于关节增强的可靠性总体较高（κ = 0.74），读者内可靠性较高至几乎完美（κ = 0.88）。读者间关于所有形态学模式的可靠性一般（κ = 0.36），在读者内练习中较高（κ = 0.68），不同模式之间存在差异。读者间（κ = 0.3）和读者内（κ = 0.4）关于诊断的可靠性一般。在对所有101例病例（47例EHOA，54例PsA）的分析中，与PsA患者相比，EHOA患者在近端指间关节（PIP）（38.98对20.00）和远端指间关节（DIP）（16.45对8.40）的平均FOI总分显著更高。关于形态学，PsA中“维尔纳征”的检出率显著高于EHOA（55.6%对21.3%；P < 0.01）。
使用预定义的评分方法可以可靠地评估FOI中的关节增强。EHOA病例中PIP和DIP关节更强的增强以及PsA病例中“维尔纳征”的出现可能有助于这两种诊断之间的鉴别诊断。
