Original Article

Clinical Rheumatology

, Volume 27, Issue 8, pp 983-989

First online:

Ultrasonography in the assessment of peripheral joint involvement in psoriatic arthritis

A comparison with radiography, MRI and scintigraphy
  • S. M. WeinerAffiliated withDepartment of Rheumatology, Immunology and Nephrology, Krankenhaus der Barmherzigen Brüder Trier, Teaching Hospital of the University of Mainz Email author 
  • , S. JurenzAffiliated withDepartment of Rheumatology and Clinical Immunology, Albert-Ludwigs-University Freiburg
  • , M. UhlAffiliated withDepartment of Radiology, Albert-Ludwigs-University
  • , A. Lange-NoldeAffiliated withDepartment of Nuclear Medicine, Albert-Ludwigs-University
  • , K. WarnatzAffiliated withDepartment of Rheumatology and Clinical Immunology, Albert-Ludwigs-University Freiburg
  • , H. H. PeterAffiliated withDepartment of Rheumatology and Clinical Immunology, Albert-Ludwigs-University Freiburg
  • , U. A. WalkerAffiliated withDepartment of Rheumatology, Felix Platter Spital, University of Basel

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The objective of our study was to investigate the role of musculoskeletal ultrasound (US) in the assessment of hand and foot small joints in psoriatic arthritis (PsA). Thirteen consecutive patients with PsA of hands or feet underwent B-mode US using a 9- to 13-MHz transducer and simultaneous magnetic resonance imaging (MRI), bone scintigraphy and radiography. US findings were compared with radiography, MRI and scintigraphy in 190, 182 and 109 joints, respectively. To assess the sensitivity and specificity of US, radiography was considered as gold standard for the detection of erosions and osteoproliferations and MRI as gold standard for the detection of joint effusion and synovitis. US, MRI and scintigraphy had a higher sensitivity in the detection of overall joint pathology than radiography in painful and/or swollen joints (71%, 72%, 82% vs 32%) and clinically unaffected joints (17%, 21%, 9% vs 2%). US and radiography detected more erosions and osteoproliferations than MRI, with low agreement between the methods in the detection of erosions. Radiography was superior to US in the visualisation of osteoproliferations. Joint effusions and/or synovitis were more frequently detected by MRI than US. Agreement between both imaging methods was better in carpal joints, carpometacarpal joint I, metacarpophalangeal (MCP)/metatarsophalangeal (MTP) joint I, II and V than in MCP/MTP III, IV, PIP and DIP joints. Compared with MRI, radiography and scintigraphy, the specificity of US ranges between 0.84 and 0.94, depending on the joint pathology. In conclusion, the diagnostic sensitivity of US in the detection of PsA-related synovitis of hands and feet is lower than MRI and depends on the joint region. However, the low cost and the acceptable specificity suggest that US is a useful imaging method in addition to radiography in PsA of hands and feet.


Magnetic resonance imaging Psoriatic arthritis Radiography Scintigraphy Ultrasonography