Clinical Rheumatology

, Volume 27, Issue 8, pp 983–989 | Cite as

Ultrasonography in the assessment of peripheral joint involvement in psoriatic arthritis

A comparison with radiography, MRI and scintigraphy
  • S. M. Weiner
  • S. Jurenz
  • M. Uhl
  • A. Lange-Nolde
  • K. Warnatz
  • H. H. Peter
  • U. A. Walker
Original Article


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 


  1. 1.
    Uhl M (1999) Radiology of the manual skeleton. 1. Inflammatory joint diseases and rheumatology. Radiologe 39:432–449PubMedCrossRefGoogle Scholar
  2. 2.
    Klarlund M, Ostergaard M, Jensen KE et al (2000) Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group. Ann Rheum Dis 59:521–528PubMedCrossRefGoogle Scholar
  3. 3.
    McGonagle D (2005) Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis. Ann Rheum Dis 64(Suppl 2):ii58–ii60PubMedCrossRefGoogle Scholar
  4. 4.
    Grassi W, Cervini C (1998) Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis 57:268–271Google Scholar
  5. 5.
    Backhaus M, Burmester GR, Gerber T et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649PubMedCrossRefGoogle Scholar
  6. 6.
    Grassi W, Lamanna G, Farina A et al (1999) Synovitis of small joints: sonographic guided diagnostic and therapeutic approach. Ann Rheum Dis 58:595–597PubMedCrossRefGoogle Scholar
  7. 7.
    Iurassich S, Rossi E, Carbone M et al (1999) Ultrasound patterns of rheumatoid and psoriatic arthritis in finger joints. Radiol Med (Torino) 98:15–18Google Scholar
  8. 8.
    Kane D, Greaney T, Bresnihan B et al (1999) Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol 26:1746–1751PubMedGoogle Scholar
  9. 9.
    Moll JM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78PubMedCrossRefGoogle Scholar
  10. 10.
    Wassenberg S, Fischer-Kahle V, Herborn G et al (2001) A method to score radiographic change in psoriatic arthritis. Z Rheumatol 60:156–166PubMedCrossRefGoogle Scholar
  11. 11.
    Wakefield RJ, Balint PV, Szkudlarek M et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487PubMedGoogle Scholar
  12. 12.
    Backhaus M, Kamradt T, Sandrock D et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245PubMedCrossRefGoogle Scholar
  13. 13.
    Szkudlarek M, Narvestad E, Klarlund M et al (2004) Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis: comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 50:2103–2112PubMedCrossRefGoogle Scholar
  14. 14.
    Schmidt WA (2005) Clinical efficacy of power and color Doppler. Ann Rheum Dis 64:8–9CrossRefGoogle Scholar
  15. 15.
    Totterman SM (2004) Magnetic resonance imaging of psoriatic arthritis: insight from traditional and three-dimensional analysis. Curr Rheumatol Rep 6:317–321PubMedCrossRefGoogle Scholar
  16. 16.
    Szkudlarek M, Court-Payen M, Strandberg C et al (2001) Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 44:2018–2023PubMedCrossRefGoogle Scholar
  17. 17.
    Schueller-Weidekamm C, Krestan C, Schueller G et al (2007) Power Doppler sonography and pulse-inversion harmonic imaging in evaluation of rheumatoid arthritis synovitis. AJR Am J Roentgenol 188:504–508PubMedCrossRefGoogle Scholar
  18. 18.
    Schmidt WA, Schmidt H, Schicke B et al (2004) Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 63:988–994PubMedCrossRefGoogle Scholar
  19. 19.
    Scheel AK, Schmidt WA, Hermann KG et al (2005) Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR “Train the trainers” course. Ann Rheum Dis 64:1043–1049PubMedCrossRefGoogle Scholar
  20. 20.
    Tan AL, Tanner SF, Conaghan PG et al (2003) Role of metacarpophalangeal joint anatomic factors in the distribution of synovitis and bone erosion in early rheumatoid arthritis. Arthritis Rheum 48:1214–1222PubMedCrossRefGoogle Scholar
  21. 21.
    Grassi W, Filippucci E, Farina A et al (2001) Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis 60:98–103PubMedCrossRefGoogle Scholar
  22. 22.
    Wakefield RJ, Gibbon WW, Conaghan PG et al (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43:2762–2770PubMedCrossRefGoogle Scholar
  23. 23.
    Backhaus M, Burmester GR, Sandrock D et al (2002) Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 61:895–904PubMedCrossRefGoogle Scholar
  24. 24.
    Holzmann H, Krause BJ, Kaltwasser JP et al (1996) Psoriatic osteoarthropathy and bone scintigraphy. Hautarzt 47:427–431PubMedCrossRefGoogle Scholar
  25. 25.
    Stoeger A, Mur E, Penz-Schneeweiss D et al (1994) Technetium-99m human immunoglobulin scintigraphy in psoriatic arthropathy: first results. Eur J Nucl Med 21:342–4PubMedCrossRefGoogle Scholar
  26. 26.
    Wakefield RJ, Green MJ, Marzo-Ortega H et al (2004) Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 63:382–385PubMedCrossRefGoogle Scholar
  27. 27.
    Hauzeur JP, Mathy L, De Maertelaer V (1999) Comparison between clinical evaluation and ultrasonography in detecting hydrarthrosis of the knee. J Rheumatol 26:2681–2683PubMedGoogle Scholar
  28. 28.
    Zanolli MD, Wikle JS (1992) Joint complaints in psoriasis patients. Int J Dermatol 31:488–491CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2008

Authors and Affiliations

  • S. M. Weiner
    • 1
  • S. Jurenz
    • 2
  • M. Uhl
    • 3
  • A. Lange-Nolde
    • 4
  • K. Warnatz
    • 2
  • H. H. Peter
    • 2
  • U. A. Walker
    • 5
  1. 1.Department of Rheumatology, Immunology and NephrologyKrankenhaus der Barmherzigen Brüder Trier, Teaching Hospital of the University of MainzTrierGermany
  2. 2.Department of Rheumatology and Clinical ImmunologyAlbert-Ludwigs-University FreiburgFreiburgGermany
  3. 3.Department of RadiologyAlbert-Ludwigs-UniversityFreiburgGermany
  4. 4.Department of Nuclear MedicineAlbert-Ludwigs-UniversityFreiburgGermany
  5. 5.Department of RheumatologyFelix Platter Spital, University of BaselBaselSwitzerland

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