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Bildgebung bei der Psoriasisarthritis und Aspekte der röntgenologischen Progression

Imaging of psoriatic arthritis and aspects of radiographic progression

Zusammenfassung

Die Psoriasisarthritis (PsA) als heterogene multifaktorielle Erkrankung mit muskuloskeletaler Beteiligung kann sich als Mon‑, Oligo- oder Polyarthritis manifestieren und bei einem Teil der Patienten auch das Achsenskelett betreffen. Häufigste Kennzeichen der Entzündung sind das Knochenmarködem und die Enthesitis. Die Früh- und Differenzialdiagnose einer PsA stellt eine klinische Herausforderung dar, insbesondere als Differenzialdiagnose zu weiteren entzündlichen oder degenerativen Gelenkerkrankungen. Durch den Einsatz der Magnetresonanztomographie (MRT), der muskuloskeletalen Sonographie (US) sowie der fluoreszenzoptischen Bildgebung (FOI) können mit hoher Sensitivität entzündliche Gelenk- und Sehnenveränderungen im Bereich der Extremitäten und der Wirbelsäule sichtbar gemacht werden. Die MRT hat, v. a. am Anfang der Erkrankung, einen prognostischen Wert bezüglich des weiteren radiographischen Krankheitsverlaufs. Durch den Einsatz der Computertomographie (CT) sowie der konventionellen Röntgenbildgebung können strukturelle Schädigungen spezifisch und zum Teil auch dreidimensional in den peripheren Gelenken und der Wirbelsäule dargestellt werden. Insbesondere die hochauflösende CT (HR-pQCT) kann pathophysiologische Vorgänge und deren morphologische Auswirkungen bereits in einem frühen Krankheitsstadium abbilden. Der Stellenwert der konventionellen Röntgendiagnostik, der Computertomographie, der Magnetresonanztomographie, der muskuloskeletalen Sonographie und alternativer bildgebender Verfahren wird hier hinsichtlich der Diagnostik und der Prognose des Verlaufs von Patienten mit PsA dargestellt.

Abstract

Psoriatic arthritis (PsA) is a heterogeneous multifactorial disease with musculoskeletal involvement, which can be manifested as monoarthritis, oligoarthritis or polyarthritis and in some patients can also affect the axial skeleton. The most frequent indications of inflammation are bone marrow edema and enthesitis. The early and differential diagnosis of PsA is a clinical challenge, particularly as a differential diagnosis from other inflammatory or degenerative diseases of joints. Inflammatory joint and tendon alterations in the region of the extremities and the spine can be visualized with high sensitivity by the use of magnetic resonance imaging (MRI), musculoskeletal sonography (US) and fluorescence optical imaging (FOI). The use of MRI has a prognostic value with respect to the further radiographic course of the disease, particularly in the initial stages of the disease. Structural damage can be specifically and also partially demonstrated 3‑dimensionally in peripheral joints and the spine by the use of computed tomography (CT) and conventional X‑ray imaging. High-resolution peripheral quantitative CT (HR-pQCT) in particular, can visualize pathophysiological processes and the morphological consequences even in early stages of the disease. The values of conventional X‑ray diagnostics, CT, MRI, musculoskeletal US and alternative imaging procedures are presented with respect to the diagnostics and prognosis of the progression of patients with PsA.

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Correspondence to PD Dr. X. Baraliakos.

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Interessenkonflikt

X. Baraliakos, A. Kleyer, D. Simon, M. Köhm, S. Ohrndorf und P. Sewerin geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Baraliakos, X., Kleyer, A., Simon, D. et al. Bildgebung bei der Psoriasisarthritis und Aspekte der röntgenologischen Progression. Z Rheumatol 79, 40–52 (2020). https://doi.org/10.1007/s00393-019-00735-9

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Schlüsselwörter

  • Konventionelle Röntgenbildgebung
  • Magnetresonanztomographie
  • Muskuloskeletaler Ultraschall
  • Computertomographie
  • Fluoreszenzoptische Bildgebung

Keywords

  • Conventional X‑ray imaging
  • Magnetic resonance imaging
  • Musculoskeletal ultrasound
  • Computed tomography
  • Fluorescence optical imaging