Skip to main content

Psoriasis and Psoriatic Arthritis: Ultrasound Applications

  • Chapter
  • First Online:
Psoriatic Arthritis and Psoriasis
  • 1835 Accesses

Abstract

Psoriatic arthritis (PsA) is an inflammatory disease with potential involvement of both peripheral and axial skeleton which has variable clinical course and several degrees of severity.

Ultrasound (US) is a rapidly evolving technique that helps to actually determine the anatomical structure involved in the inflammatory process and is one of the imaging method recommended to assess synovitis at any joint and has the potential to be used not only to detect joint synovitis, but also to assess surrounding soft tissues in order to determine the presence of tenosynovitis, dactylitis and/or enthesitis.

Doppler modalities are currently considered an integral part of the global US assessment of the rheumatic patient. This is mainly due to their capability to detect pathological flow within musculoskeletal soft tissues, thereby demonstrating the presence of local active inflammation.

US has several advantages over other imaging techniques: it is patient-friendly, safe, noninvasive, less expensive, and permits multiple target assessment in real time without the need for external referral.

Available data demonstrate that US can be regarded as a feasible and effective imaging technique that can allow early recognition of anatomical changes, inflammatory subclinical findings, differential diagnosis, careful guidance for aspiration and/or local treatment, and short-term therapy monitoring at joint, tendon, enthesis, nail, and skin levels.

Further research is required into implications of the disparity between US and clinical findings, to really determine the significance of subclinical findings to predict structural damage, relapse and progression of the disease. There is also a need to validate PsA specific composite multi-target US scoring systems.

This chapter summarize the main potential applications of US in cutaneous psoriasis and PsA patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Coates LC, Hodgson R, Conaghan PG, Freeston JE. MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis. Best Pract Res Clin Rheumatol. 2012;26(6):805–22.

    Article  PubMed  Google Scholar 

  2. Grassi W, Gutierrez M. Psoriatic arthritis: need for ultrasound in everyday clinical practice. J Rheumatol Suppl. 2012;89:39–43.

    Article  PubMed  Google Scholar 

  3. Riente L, Carli L, Delle Sedie A. Ultrasound imaging in psoriatic arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2014;32(1 Suppl 80):S26–33.

    PubMed  Google Scholar 

  4. Klauser AS, Tagliafico A, Allen GM, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol. 2012;22(5):1140–8.

    Article  PubMed  Google Scholar 

  5. Backhaus M, Burmester GR, Gerber T, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis. 2001;60(7):641–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Porta F, Radunovic G, Vlad V, et al. The role of Doppler ultrasound in rheumatic diseases. Rheumatology (Oxford). 2012;51(6):976–82.

    Article  Google Scholar 

  7. Torp-Pedersen ST, Terslev L. Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis. 2008;67(2):143–9.

    Article  PubMed  CAS  Google Scholar 

  8. Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W. Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis. 2011;70(6):1111–4.

    Article  PubMed  Google Scholar 

  9. Naredo E, Monteagudo I. Doppler techniques. Clin Exp Rheumatol. 2014;32(1 Suppl 80):S12–9.

    PubMed  Google Scholar 

  10. Naredo E, Batlle-Gualda E, Garcia-Vivar ML, et al. Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. J Rheumatol. 2010;37(10):2110–7.

    Article  PubMed  Google Scholar 

  11. Gutierrez M, Filippucci E, Grassi W, Rosemffet M. Intratendinous power Doppler changes related to patient position in seronegative spondyloarthritis. J Rheumatol. 2010;37(5):1057–9.

    Article  PubMed  Google Scholar 

  12. Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–7.

    PubMed  Google Scholar 

  13. Husic R, Gretler J, Felber A, et al. Disparity between ultrasound and clinical findings in psoriatic arthritis. Ann Rheum Dis. 2014;73(8):1529–36.

    Article  PubMed  Google Scholar 

  14. Freeston JE, Coates LC, Nam JL, et al. Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care Res (Hoboken). 2014;66(3):432–9.

    Article  Google Scholar 

  15. El Miedany Y, El Gaafary M, Youssef S, Ahmed I, Nasr A. Tailored approach to early psoriatic arthritis patients: clinical and ultrasonographic predictors for structural joint damage. Clin Rheumatol. 2015;34(2):307–13.

    Article  PubMed  Google Scholar 

  16. Ghosh A, Mondal S, Sinha D, Nag A, Chakraborty S. Ultrasonography as a useful modality for documenting sacroiliitis in radiographically negative inflammatory back pain: a comparative evaluation with MRI. Rheumatology (Oxford). 2014;53(11):2030–4.

    Article  Google Scholar 

  17. Klauser A, Halpern EJ, Frauscher F, et al. Inflammatory low back pain: high negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Rheum. 2005;53(3):440–4.

    Article  PubMed  Google Scholar 

  18. Terslev L, Naredo E, Iagnocco A, et al. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken). 2014;66(5):741–8.

    Article  CAS  Google Scholar 

  19. Falcao S, de Miguel E, Castillo-Gallego C, Peiteado D, Branco J, Martin Mola E. Achilles enthesis ultrasound: the importance of the bursa in spondyloarthritis. Clin Exp Rheumatol. 2013;31(3):422–7.

    PubMed  Google Scholar 

  20. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61(10):905–10.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  21. de Miguel E, Cobo T, Munoz-Fernandez S, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009;68(2):169–74.

    Article  PubMed  Google Scholar 

  22. Bakewell CJ, Olivieri I, Aydin SZ, et al. Ultrasound and magnetic resonance imaging in the evaluation of psoriatic dactylitis: status and perspectives. J Rheumatol. 2013;40(12):1951–7.

    Article  PubMed  Google Scholar 

  23. Fournie B, Margarit-Coll N, Champetier de Ribes TL, et al. Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine. 2006;73(5):527–31.

    Article  PubMed  Google Scholar 

  24. Gutierrez M, Wortsman X, Filippucci E, De Angelis R, Filosa G, Grassi W. High-frequency sonography in the evaluation of psoriasis: nail and skin involvement. J Ultrasound Med. 2009;28(11):1569–74.

    PubMed  Google Scholar 

  25. Gisondi P, Tinazzi I, El-Dalati G, et al. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study. Ann Rheum Dis. 2008;67(1):26–30.

    Article  PubMed  CAS  Google Scholar 

  26. Gutierrez M, Filippucci E, De Angelis R, et al. Subclinical entheseal involvement in patients with psoriasis: an ultrasound study. Semin Arthritis Rheum. 2011;40(5):407–12.

    Article  PubMed  Google Scholar 

  27. Ash ZR, Tinazzi I, Gallego CC, et al. Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails. Ann Rheum Dis. 2012;71(4):553–6.

    Article  PubMed  Google Scholar 

  28. Naredo E, Moller I, de Miguel E, et al. High prevalence of ultrasonographic synovitis and enthesopathy in patients with psoriasis without psoriatic arthritis: a prospective case–control study. Rheumatology (Oxford). 2011;50(10):1838–48.

    Article  Google Scholar 

  29. Tinazzi I, McGonagle D, Biasi D, et al. Preliminary evidence that subclinical enthesopathy may predict psoriatic arthritis in patients with psoriasis. J Rheumatol. 2011;38(12):2691–2.

    Article  PubMed  Google Scholar 

  30. Wiell C, Szkudlarek M, Hasselquist M, et al. Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res Ther. 2007;9(6):R119.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage. 2009;17(2):178–81.

    Article  PubMed  CAS  Google Scholar 

  32. Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007;46(7):1116–21.

    Article  CAS  Google Scholar 

  33. Aydin SZ, Karadag O, Filippucci E, et al. Monitoring Achilles enthesitis in ankylosing spondylitis during TNF-alpha antagonist therapy: an ultrasound study. Rheumatology (Oxford). 2010;49(3):578–82.

    Article  CAS  Google Scholar 

  34. Ruta S, Acosta Felquer ML, Rosa J, Navarta DA, Garcia Monaco R, Soriano ER. Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients. Clin Rheumatol. 2015;34(1):125–32.

    Article  PubMed  Google Scholar 

  35. Ficjan A, Husic R, Gretler J, et al. Ultrasound composite scores for the assessment of inflammatory and structural pathologies in Psoriatic Arthritis (PsASon-Score). Arthritis Res Ther. 2014;16(5):476.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Gutierrez M, Filippucci E, Bertolazzi C, Grassi W. Sonographic monitoring of psoriatic plaque. J Rheumatol. 2009;36(4):850–1.

    Article  PubMed  Google Scholar 

  37. De Agustin JJ, Moragues C, De Miguel E, et al. A multicentre study on high-frequency ultrasound evaluation of the skin and joints in patients with psoriatic arthritis treated with infliximab. Clin Exp Rheumatol. 2012;30(6):879–85.

    PubMed  Google Scholar 

  38. Gutierrez M, De Angelis R, Bernardini ML, et al. Clinical, power Doppler sonography and histological assessment of the psoriatic plaque: short-term monitoring in patients treated with etanercept. Br J Dermatol. 2011;164(1):33–7.

    Article  PubMed  CAS  Google Scholar 

  39. Gutierrez M, Di Geso L, Salaffi F, et al. Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxford). 2012;51(7):1261–8.

    Article  Google Scholar 

  40. Balint PV, Kane D, Sturrock RD. Modern patient management in rheumatology: interventional musculoskeletal ultrasonography. Osteoarthritis Cartilage. 2001;9(6):509–11.

    Article  PubMed  CAS  Google Scholar 

  41. Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis. 1997;56(1):59–63.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  42. Jones A, Regan M, Ledingham J, Pattrick M, Manhire A, Doherty M. Importance of placement of intra-articular steroid injections. BMJ. 1993;307(6915):1329–30.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Balint PV, Kane D, Hunter J, McInnes IB, Field M, Sturrock RD. Ultrasound guided versus conventional joint and soft tissue fluid aspiration in rheumatology practice: a pilot study. J Rheumatol. 2002;29(10):2209–13.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Magaly Alva MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Ruta, S., Alva, M. (2016). Psoriasis and Psoriatic Arthritis: Ultrasound Applications. In: Adebajo, A., Boehncke, WH., Gladman, D., Mease, P. (eds) Psoriatic Arthritis and Psoriasis. Springer, Cham. https://doi.org/10.1007/978-3-319-19530-8_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19530-8_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19529-2

  • Online ISBN: 978-3-319-19530-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics