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Magnetic resonance imaging (MRI) of feet demonstrates subclinical inflammatory joint disease in cutaneous psoriasis patients without clinical arthritis

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Abstract

We evaluated inflammation at the small joints of feet in psoriasis patients without clinical arthritis (PsO) as against clinically overt psoriatic arthritis (PsA) patients, using a low field magnet extremity MRI (eMRI). Patients with psoriasis recruited from dermatology and rheumatology clinics of a tertiary care institution in southern India were divided into PsO and PsA groups. Demographic and physical examination details were recorded. Consenting patients underwent non-contrast eMRI of the right foot. Two trained readers scored the MRI parameters of inflammation (synovitis, tenosynovitis, osteitis) using a modification of the PsA magnetic resonance imaging score (PsAMRIS). Proportion of patients with any sign of MRI inflammation was noted. Clinical variables were compared with inflammation scores for any association. A total of 83 patients (30 PsA and 53 PsO), with 75% males and mean age of 42.2 ± 11.6 years were included. There was no statistical difference between the median eMRI inflammatory scores in PsA and PsO patients (p = 0.493). Evidence of inflammation was present in 33.9% and 50% patients in the PsO and PsA groups, respectively. Early arthritis for psoriatic patients screening questionnaire (EARP) score of ≥ 3 was significantly associated with imaging features of inflammation in PsO group (p = 0.044). This study corroborates a high proportion of subclinical inflammation in small joints of foot in PsO patients, which needs to be reproduced in larger, longitudinal cohorts to predict risk factors for progression to future PsA development.

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Acknowledgements

We are grateful to the patients who participated in this research study. We thank Rasu E for his role in performing the MRI scans. This work was presented as a poster at the EULAR 2017 in Madrid, Spain.

Funding

This study is supported by the Asia Pacific League of Associations for Rheumatology (APLAR) Research Grant 2015 and Christian Medical College, Vellore Institutional fluid grant.

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Authors and Affiliations

  1. Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, 632 004, India

    Ashish J. Mathew & Debashish Danda

  2. University of NSW, Sydney, Australia

    Paul Bird

  3. Department of Dermatology, Christian Medical College, Vellore, India

    Ankan Gupta & Renu George

Authors
  1. Ashish J. Mathew
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  2. Paul Bird
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  3. Ankan Gupta
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  4. Renu George
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  5. Debashish Danda
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Contributions

AM was responsible for planning, execution, patient examination, MRI scoring, preparing the initial manuscript draft and completing manuscript revision. PB was the second scorer for MRI and critically revised the manuscript. AG participated by recruiting patients for this study and critically revising the manuscript. RG helped in design of the study and critically revised the manuscript. DD acted as the supervisor for this study, helping in designing, interpreting data and critically revising the manuscript. All authors have approved the final manuscript.

Corresponding author

Correspondence to Debashish Danda.

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Ethics approval and registration

Christian Medical College Institution Review Board and Ethics Committee (IRB Min. No 9543 dt 22.07.15, CMC Vellore).

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Mathew, A.J., Bird, P., Gupta, A. et al. Magnetic resonance imaging (MRI) of feet demonstrates subclinical inflammatory joint disease in cutaneous psoriasis patients without clinical arthritis. Clin Rheumatol 37, 383–388 (2018). https://doi.org/10.1007/s10067-017-3895-z

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  • DOI: https://doi.org/10.1007/s10067-017-3895-z

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