Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Rheumatology Reports
Published in: Current Rheumatology Reports 12/2018

01-12-2018 | Psoriatic Arthritis (J Scher, Section Editor)

Imaging in Psoriatic Arthritis—Insights About Pathogenesis of the Disease

Authors: Lihi Eder, Sibel Zehra Aydin

Published in: Current Rheumatology Reports | Issue 12/2018

Login to get access

Abstract

Purpose of Review

Heterogeneity is a hallmark of PsA as musculoskeletal inflammation can affect different tissues including the synovial joint, tendons, entheses, bursa, and bone.

Recent Findings

Relying on clinical examination for investigating underlying mechanisms in PsA is limited by the inherent inaccuracies of examination of the joints, enthesis, and spine. In addition, unlike synovial-centered diseases, histology is hard to obtain for the entheses and spine, limiting the knowledge for different manifestations of PsA. These limitations prompted the use of imaging modalities to improve our understanding of the underlying mechanisms in PsA. Imaging modalities can identify and quantify the extent of inflammation and damage in the synovial joints, entheses, and tendons which all contribute to the heterogeneity of PsA.

Summary

This review summarizes the contribution of imaging to the understanding of the underlying mechanisms of different clinical manifestations of PsA.
Literature
1.
Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376(10):957–70.CrossRef
2.
Gladman DD. Recent advances in understanding and managing psoriatic arthritis. F1000Res. 2016;5:2670.CrossRef
3.
Ostergaard M, Eder L, Christiansen SN, Kaeley GS. Imaging in the diagnosis and management of peripheral psoriatic arthritis-the clinical utility of magnetic resonance imaging and ultrasonography. Best Pract Res Clin Rheumatol. 2016;30(4):624–37.CrossRef
4.
McGonagle D. Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease. J Eur Acad Dermatol Venereol. 2009;23(Suppl 1):9–13.CrossRef
5.
McGonagle D, Gibbon W, Emery P. Classification of inflammatory arthritis by enthesitis. Lancet. 1998;352(9134):1137–40.CrossRef
6.
Schett G, Lories RJ, D'Agostino MA, Elewaut D, Kirkham B, Soriano ER, et al. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol. 2017;13(12):731–41.CrossRef
7.
Husic R, Gretler J, Felber A, Graninger WB, Duftner C, Hermann J, et al. Disparity between ultrasound and clinical findings in psoriatic arthritis. Ann Rheum Dis. 2014;73(8):1529–36.CrossRef
8.
Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis. 1971;30(3):213–23.CrossRef
9.
Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S. The “enthesis organ” concept: why enthesopathies may not present as focal insertional disorders. Arthritis Rheum. 2004;50(10):3306–13.CrossRef
10.
Thomopoulos S, Genin GM, Galatz LM. The development and morphogenesis of the tendon-to-bone insertion - what development can teach us about healing. J Musculoskelet Neuronal Interact. 2010;10(1):35–45.PubMedPubMedCentral
11.
Aydin SZ, Bas E, Basci O, Filippucci E, Wakefield RJ, Celikel C, et al. Validation of ultrasound imaging for Achilles entheseal fibrocartilage in bovines and description of changes in humans with spondyloarthritis. Ann Rheum Dis. 2010;69(12):2165–8.CrossRef
12.
Gandjbakhch F, Terslev L, Joshua F, Wakefield RJ, Naredo E, D'Agostino MA, et al. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res. Ther. 2011;13(6):R188.CrossRef
13.
Eder L, Jayakar J, Thavaneswaran A, Haddad A, Chandran V, Salonen D, et al. Is the MAdrid Sonographic Enthesitis Index useful for differentiating psoriatic arthritis from psoriasis alone and healthy controls? J Rheumatol. 2014;41(3):466–72.CrossRef
14.
Wervers K, Vis M, Rasappu N, van der Ven M, Tchetverikov I, Kok MR, et al. Modification of a sonographic enthesitis score to differentiate between psoriatic arthritis and young healthy volunteers. Scand J Rheumatol. 2018;47(4):291–4.CrossRef
15.
Solmaz DBS, Stephenson W, Eder L, Roth J, Aydın SZ. The physiological changes of the enthesis in response to age, body mass index and physical activity: an ultrasound study in healthy people. Arthritis Rheum. 2018;70(Suppl 10):1194.
16.
Balint P, Kane D, Wilson H, McInnes IB, Sturrock R. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61:905–10.CrossRef
17.
D’Agostino MA. Ultrasound imaging in spondyloarthropathies. Best Pract Res Clin Rheumatol. 2010;24(5):693–700.CrossRef
18.
Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, et al. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res. 2014;66(5):741–8.CrossRef
19.
Balint PV, Terslev L, Aegerter P, Bruyn GAW, Chary-Valckenaere I, Gandjbakhch F, et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis. 2018:annrheumdis-2018-213609.
20.
Aydin SZ, Ash ZR, Tinazzi I, Castillo-Gallego C, Kwok C, Wilson C, et al. The link between enthesitis and arthritis in psoriatic arthritis: a switch to a vascular phenotype at insertions may play a role in arthritis development. Ann Rheum Dis. 2013;72(6):992–5.CrossRef
21.
Eder L, Chandran V, Pellet F, Shanmugarajah S, Rosen CF, Bull SB, et al. Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2012;71(1):50–5.CrossRef
22.
Tang Y, Yang Y, Xiang X, Wang L, Zhang L, Qiu L. Power Doppler ultrasound evaluation of peripheral joint, entheses, tendon, and bursa abnormalities in psoriatic patients: a clinical study. J Rheumatol. 2018;45(6):811–7.CrossRef
23.
Ash ZR, Tinazzi I, Gallego CC, Kwok C, Wilson C, Goodfield M, 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.CrossRef
24.
Tinazzi I, McGonagle D, Biasi D, Confente S, Caimmi C, Girolomoni G, et al. Preliminary evidence that subclinical enthesopathy may predict psoriatic arthritis in patients with psoriasis. J Rheumatol. 2011;38(12):2691–2.CrossRef
25.
Polachek A, Cook R, Chandran V, Gladman DD, Eder L. The association between sonographic enthesitis and radiographic damage in psoriatic arthritis. Arthritis Res. Ther. 2017;19(1):189.CrossRef
26.
Aydin SZ, Can M, Alibaz-Oner F, Keser G, Kurum E, Inal V, et al. A relationship between spinal new bone formation in ankylosing spondylitis and the sonographically determined Achilles tendon enthesophytes. Rheumatol Int. 2016;36(3):397–404.CrossRef
27.
Tan AL, Benjamin M, Toumi H, Grainger AJ, Tanner SF, Emery P, et al. The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis--a high-resolution MRI and histological study. Rheumatology (Oxford). 2007;46(2):253–6.CrossRef
28.
Arbault A, Devilliers H, Laroche D, Cayot A, Vabres P, Maillefert JF, et al. Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis. Joint Bone Spine. 2016;83(5):539–44.CrossRef
29.
Aydin SZ, Castillo-Gallego C, Ash ZR, Abignano G, Marzo-Ortega H, Wittmann M, et al. Potential use of optical coherence tomography and high-frequency ultrasound for the assessment of nail disease in psoriasis and psoriatic arthritis. Dermatology. 2013;227(1):45–51.CrossRef
30.
Aydin SZ, Castillo-Gallego C, Ash ZR, Marzo-Ortega H, Emery P, Wakefield RJ, et al. Ultrasonographic assessment of nail in psoriatic disease shows a link between onychopathy and distal interphalangeal joint extensor tendon enthesopathy. Dermatology. 2012;225(3):231–5.CrossRef
31.
Acquitter M, Misery L, Saraux A, Bressollette L, Jousse-Joulin S. Detection of subclinical ultrasound enthesopathy and nail disease in patients at risk of psoriatic arthritis. Joint Bone Spine. 2017;84(6):703–7.CrossRef
32.
Marina ME, Solomon C, Bolboaca SD, Bocsa C, Mihu CM, Tataru AD. High-frequency sonography in the evaluation of nail psoriasis. Med Ultrason. 2016;18(3):312–7.CrossRef
33.
Aydin SZ, Castillo-Gallego C, Ash ZR, Marzo-Ortega H, Wakefield R, McGonagle D. Vascularity of nail bed by ultrasound to discriminate psoriasis, psoriatic arthritis and healthy controls. Clin Exp Rheumatol. 2017;35(5):872.PubMed
34.
Acosta-Felquer ML, Ruta S, Rosa J, Marin J, Ferreyra-Garrot L, Galimberti ML, et al. Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory. Semin Arthritis Rheum. 2017;47(3):338–42.CrossRef
35.
Moya Alvarado P, Roe Crespo E, Munoz-Garza FZ, Lopez-Ferrer A, Laiz Alonso A, Vilarrassa Rull E, et al. Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease. J Eur Acad Dermatol Venereol. 2018;32:1728–36.CrossRef
36.
Bakirci Ureyen S, Kara RO, Erturk Z, Yaldiz M. The microvascular and morphostructural changes of nails in psoriatic patients with nail disease; a link between ultrasound and videocapillaroscopy findings in the nailfold. Med Ultrason. 2018;20(2):185–91.CrossRef
37.
Husein El-Ahmed H, Garrido-Pareja F, Ruiz-Carrascosa JC, Naranjo-Sintes R. Vessel resistance to blood flow in the nailfold in patients with psoriasis: a prospective case-control echo Doppler-based study. Br J Dermatol. 2012;166(1):54–8.CrossRef
38.
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.CrossRef
39.
Zabotti A, Salvin S, Quartuccio L, De Vita S. Differentiation between early rheumatoid and early psoriatic arthritis by the ultrasonographic study of the synovio-entheseal complex of the small joints of the hands. Clin Exp Rheumatol. 2016;34(3):459–65.PubMed
40.
Fournie B, Margarit-Coll N, Champetier de Ribes TL, Zabraniecki L, Jouan A, Vincent V, 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.CrossRef
41.
Milz S, Putz R, Ralphs JR, Benjamin M. Fibrocartilage in the extensor tendons of the human metacarpophalangeal joints. Anat Rec. 1999;256(2):139–45.CrossRef
42.
Benjamin M, McGonagle D. The enthesis organ concept and its relevance to the spondyloarthropathies. Adv Exp Med Biol. 2009;649:57–70.CrossRef
43.
Milz S, McNeilly C, Putz R, Ralphs JR, Benjamin M. Fibrocartilages in the extensor tendons of the interphalangeal joints of human toes. Anat Rec. 1998;252(2):264–70.CrossRef
44.
Zabotti A, Errichetti E, Zuliani F, Quartuccio L, Sacco S, Stinco G, et al. Early psoriatic arthritis versus early seronegative rheumatoid arthritis: role of dermoscopy combined with ultrasonography for differential diagnosis. J Rheumatol. 2018;45(5):648–54.CrossRef
45.
Brockbank JE, Stein M, Schentag CT, Gladman DD. Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis. 2005;64(2):188–90.CrossRef
46.
Olivieri I, Barozzi L, Favaro L, Pierro A, de Matteis M, Borghi C, et al. Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum. 1996;39(9):1524–8.CrossRef
47.
Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis. 2015;74(1):185–9.CrossRef
48.
Tuttle KS, Vargas SO, Callahan MJ, Bae DS, Nigrovic PA. Enthesitis as a component of dactylitis in psoriatic juvenile idiopathic arthritis: histology of an established clinical entity. Pediatr Rheumatol Online J. 2015;13:7.CrossRef
49.
Tinazzi I, McGonagle D, Aydin SZ, Chessa D, Marchetta A, Macchioni P. Deep Koebner’ phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. Ann Rheum Dis. 2018;77(6):922–5.CrossRef
50.
Zabotti A, Piga M, Canzoni M, Sakellariou G, Iagnocco A, Scire CA, et al. Ultrasonography in psoriatic arthritis: which sites should we scan? Ann Rheum Dis. 2018.
51.
Gremese E, Bernardi S, Bonazza S, Nowik M, Peluso G, Massara A, et al. Body weight, gender and response to TNF-alpha blockers in axial spondyloarthritis. Rheumatology (Oxford). 2014;53(5):875–81.CrossRef
52.
Love TJ, Zhu Y, Zhang Y, Wall-Burns L, Ogdie A, Gelfand JM, et al. Obesity and the risk of psoriatic arthritis: a population-based study. Ann Rheum Dis. 2012;71(8):1273–7.CrossRef
53.
Eder L, Thavaneswaran A, Chandran V, Cook RJ, Gladman DD. Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis. 2015;74(5):813–7.CrossRef
54.
Egeberg A, Sorensen JA, Gislason GH, Knop FK, Incidence SL. Prognosis of psoriasis and psoriatic arthritis in patients undergoing bariatric surgery. JAMA Surg. 2017;152(4):344–9.CrossRef
55.
Thorarensen SM, Lu N, Ogdie A, Gelfand JM, Choi HK, Love TJ. Physical trauma recorded in primary care is associated with the onset of psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2017;76(3):521–5.CrossRef
56.
Zhou W, Chandran V, Cook R, Gladman DD, Eder L. The association between occupational-related mechanical stress and radiographic damage in psoriatic arthritis. Semin Arthritis Rheum. 2018.
57.
Megna M, Gisonni P, Napolitano M, Orabona GD, Patruno C, Ayala F, et al. The effect of smartphone addiction on hand joints in psoriatic patients: an ultrasound-based study. J Eur Acad Dermatol Venereol. 2018;32(1):73–8.CrossRef
58.
FA. A, EK. G, E. K, S. B, AB O, D M, et al. Greater magnitude of entheseal microdamage and repair in psoriatic arthritis compared with ankylosing spondylitis on ultrasound. Rheumatology (Oxford). 2018;in press.
Metadata
Title
Imaging in Psoriatic Arthritis—Insights About Pathogenesis of the Disease
Authors
Lihi Eder
Sibel Zehra Aydin
Publication date
01-12-2018
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 12/2018
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-018-0793-6

Other articles of this Issue 12/2018

Current Rheumatology Reports 12/2018 Go to the issue

Complementary and Alternative Medicine (S Kolasinski, Section Editor)

Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis

Imaging (D Mintz, Section Editor)

Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift

Chronic Pain (R Staud, Section Editor)

Clinical Perspective on Pain and Pain Phenotypes in Osteoarthritis

Osteoarthritis (M Goldring, Section Editor)

Pharmacological Treatment of Pain in Osteoarthritis: A Descriptive Review

Vasculitis (L Espinoza, Section Editor)

Autoinflammatory Disease-Associated Vasculitis/Vasculopathy

Health Economics and Quality of Life (N Tsao, Section Editor)

Anxiety and Mood Disorders in Systemic Lupus Erythematosus: Current Insights and Future Directions
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits