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The role of ultrasound in screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis

  • Musculoskeletal
  • Published:
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A Commentary to this article was published on 13 April 2023

Abstract

Objective

To identify patients in the subclinical psoriatic arthritis (Sub-PsA) phase by ultrasound (US) and provide a solution to screen them.

Methods

A total of 490 participants with moderate-to-severe psoriasis were evaluated. Among them, 384 participants without arthritis symptoms were enrolled into the silent psoriasis group and 106 participants with arthritis symptoms, called prodromal/active PsA phase, were enrolled into the clinical PsA group. Another 80 non-psoriasis participants were enrolled into the control group. Each participant received clinical assessments and US examinations of 60 joints, 38 tendons, and 40 entheses. We compared the incidences of synovio-enthesitis, synovitis, tenosynovitis, erosion, and dactylitis detected on US among the three groups. Subsequently, on the basis of significant US findings, we distinguished Sub-PsA from psoriasis alone (PsO) in the silent psoriasis group and analyzed the clinical characteristics, mainly including basic clinical characteristics, body surface area (BSA), and Psoriasis Area and Severity Index (PASI) score.

Results

Only synovio-enthesitis significantly differed between the control group and the silent psoriasis group (1.3% vs. 16.1%, p < 0.001). The knee was the most commonly involved site of synovio-enthesitis (79.0%). Taking synovio-enthesitis as the standard, 16.1% of silent psoriasis participants and 12.7% of all psoriasis participants were in the Sub-PsA phase. Furthermore, there were no differences in BSA and PASI among the three phases of PsO, Sub-PsA, and prodromal/active PsA.

Conclusions

Since the psoriasis patients in Sub-PsA phase was as high as 12.7% in all patients with moderate-to-severe psoriasis, US-detected synovio-enthesitis was recommended routinely for screening them regardless of arthritis symptoms, especially in the lower limbs.

Key Points

• Synovio-enthesitis on ultrasound was significantly associated with subclinical psoriatic arthritis, especially in the lower limbs.

• Routine ultrasound evaluation could help screen psoriasis patients in the subclinical psoriatic arthritis phase, which was as high as 12.7% in all psoriasis patients.

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Abbreviations

BMI:

Body mass index

BSA:

Body surface area

PASI:

Psoriasis Area and Severity Index

PsO:

Psoriasis participants without any arthritis symptoms, and no evidence of synovio-enthesitis in the US

Sub-PsA:

Psoriasis participants without any clinical arthritis symptoms, but with evidence of synovio-enthesitis in the US

Prodromal PsA:

Psoriasis participants with arthritis symptoms but CASPAR scores  < 3

Active PsA:

Psoriasis participants with arthritis symptoms and CASPAR scores  ≥ 3

Control group:

Non-psoriasis controls

Silent psoriasis group:

Psoriasis participants without arthritis symptoms, including the phases of PsO (psoriasis alone) and Sub-PsA

Clinical PsA group:

Psoriasis participants with arthritis symptoms, including the phases of prodromal PsA and active PsA

US:

Ultrasound

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Funding

This study was financially supported by the National Natural Science Foundation of China, Grant/Award Numbers: 82151318, 81927801, 82072092, 81901753, 82001816, 82273510, 82073429; Fundamental Research Funds for the Central Universities, Grant/Award Number: 22120190213; Shanghai Municipal Health Commission, Grant/Award Numbers: 2019LJ21, SHSLCZDZK03502; Science and Technology Commission of Shanghai Municipality, Grant/Award Numbers: 19441903200, 19DZ2251100; Innovation Program of Shanghai Municipal Education Commission (No.2019–01-07–00-07-E00046); Clinical Research Plan of SHDC (No. SHDC2020CR1014B); and Program of Shanghai Academic Research Leader (No. 20XD1403300).

Author information

Author notes

  1. Zi-Tong Chen and Rong-Fen Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China

    Zi-Tong Chen, Qiao Wang, Wei-Wei Ren, Dan-Dan Shan, Li-Ping Sun & Le-Hang Guo

  2. Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China

    Zi-Tong Chen, Qiao Wang, Wei-Wei Ren, Dan-Dan Shan, Li-Ping Sun & Le-Hang Guo

  3. Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China

    Zi-Tong Chen, Qiao Wang, Wei-Wei Ren, Dan-Dan Shan, Li-Ping Sun & Le-Hang Guo

  4. Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, School of Medicine, Tongji University, Shanghai, 200443, China

    Rong-Fen Chen & Yu-Ling Shi

  5. Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, China

    Xiao-Long Li & Hui-Xiong Xu

  6. Department of Medical Imaging, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China

    Yu-Jing Zhao

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  1. Zi-Tong Chen
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Corresponding authors

Correspondence to Hui-Xiong Xu, Yu-Ling Shi or Le-Hang Guo.

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The scientific guarantor of this publication is Le-Hang Guo.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• prospective

• diagnostic study

• multicenter study

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Chen, ZT., Chen, RF., Li, XL. et al. The role of ultrasound in screening subclinical psoriatic arthritis in patients with moderate to severe psoriasis. Eur Radiol 33, 3943–3953 (2023). https://doi.org/10.1007/s00330-023-09493-4

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