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Review of the Use of Ultrasound for the Diagnosis and Monitoring of Enthesitis in Psoriatic Arthritis

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Abstract

Musculoskeletal ultrasound is rapidly advancing, with contemporary machines offering exquisite high-resolution pictures of superficial structures such as tendons, ligaments, bursae, and joints. It is a useful tool that maybe used to evaluate patients with psoriasis and psoriatic arthritis. High-resolution transducers readily depict ultrastructural changes in the entheses and surrounding structures, while Doppler modalities elicit signs of increased blood flow, suggesting inflammation. Some of the findings seen at the entheses of psoriatic patients maybe viewed in an alternative framework of an enthesis organ concept. There are limited studies that search for the presence of enthesopathy in patients with psoriatic arthritis. Most of these examine lower extremity entheses with heterogeneous scoring methods. Similar indices have been used to examine patients with psoriasis to elucidate signs of early or occult psoriatic enthesitis. Although ultrastructural differences have been noted compared with control groups, longitudinal data are lacking with regard to placing these changes in the context of future development of psoriatic arthritis or functional outcome.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gisondi P, Tinazzi I, El-Dalati G, et al. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study. Ann Rheum Dis. 2008;67:26–30.

    Article  PubMed  CAS  Google Scholar 

  2. Grassi W, Gutierrez M, Filippucci E. The sound of enthesis. J Rheumatol. 2010;37:1986–8.

    Article  PubMed  Google Scholar 

  3. Benjamin M, McGonagle D. The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat. 2001;199:503–26.

    Article  PubMed  CAS  Google Scholar 

  4. Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32:2485–7.

    PubMed  Google Scholar 

  5. Alcalde M, Acebes JC, Cruz M, et al. A Sonographic Enthesitic Index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis. 2007;66:1015–9.

    Article  PubMed  CAS  Google Scholar 

  6. De Simone C, Guerriero C, Giampetruzzi AR, et al. Achilles tendinitis in psoriasis: clinical and sonographic findings. J Am Acad Dermatol. 2003;49:217–22.

    Article  PubMed  Google Scholar 

  7. McGonagle D, Lories RJ, Tan AL, Benjamin M. The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum. 2007;56:2482–91.

    Article  PubMed  Google Scholar 

  8. Benjamin M, McGonagle D. Histopathologic changes at “synovio-entheseal complexes” suggesting a novel mechanism for synovitis in osteoarthritis and spondylarthritis. Arthritis Rheum. 2007;56:3601–9.

    Article  PubMed  Google Scholar 

  9. Galluzzo E, Lischi DM, Taglione E, et al. Sonographic analysis of the ankle in patients with psoriatic arthritis. Scand J Rheumatol. 2000;29:52–5.

    Article  PubMed  CAS  Google Scholar 

  10. D’Agostino MA, Olivieri I. Enthesitis. Best Pract Res Clin Rheumatol. 2006;20:473–86.

    Article  PubMed  Google Scholar 

  11. Kane D, Greaney T, Bresnihan B, et al. Ultrasonography in the diagnosis and management of psoriatic dactylitis. J Rheumatol. 1999;26:1746–51.

    PubMed  CAS  Google Scholar 

  12. Olivieri I, Padula A, Scarano E, Scarpa R. Dactylitis or “sausage-shaped” digit. J Rheumatol. 2007;34:1217–22.

    PubMed  Google Scholar 

  13. Wakefield RJ, Emery P, Veale D. Ultrasonography and psoriatic arthritis. J Rheumatol. 2000;27:1564–5.

    PubMed  CAS  Google Scholar 

  14. Healy PJ, Groves C, Chandramohan M, Helliwell PS. MRI changes in psoriatic dactylitis—extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatol Oxf. 2008;47:92–5.

    Article  CAS  Google Scholar 

  15. Fournie B, Margarit-Coll N, Champetier de Ribes TL, et al. Extrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis. Joint Bone Spine. 2006;73:527–31.

    Article  PubMed  Google Scholar 

  16. McGonagle D, Marzo-Ortega H, Benjamin M, Emery P. Report on the Second International Enthesitis Workshop. Arthritis Rheum. 2003;48:896–905.

    Article  PubMed  Google Scholar 

  17. Schmidt WA, Backhaus M. What the practising rheumatologist needs to know about the technical fundamentals of ultrasonography. Best Pract Res Clin Rheumatol. 2008;22:981–99.

    Article  PubMed  Google Scholar 

  18. • Torp-Pedersen ST, Terslev L. Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis. 2008;67:143–9. In this contribution, the authors summarize the effects of various settings on Doppler sensitivity.

    Article  PubMed  CAS  Google Scholar 

  19. Gutierrez M, Filippucci E, Grassi W, Rosemffet M. Intratendinous power Doppler changes related to patient position in seronegative spondyloarthritis. J Rheumatol. 2010;37:1057–9.

    Article  PubMed  Google Scholar 

  20. D’Agostino MA, Said-Nahal R, Hacquard-Bouder C, et al. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum. 2003;48:523–33.

    Article  PubMed  Google Scholar 

  21. Morel M, Boutry N, Demondion X, et al. Normal anatomy of the heel entheses: anatomical and ultrasonographic study of their blood supply. Surg Radiol Anat. 2005;27:176–83.

    Article  PubMed  CAS  Google Scholar 

  22. McGonagle D, Marzo-Ortega H, O’Connor P, et al. Histological assessment of the early enthesitis lesion in spondyloarthropathy. Ann Rheum Dis. 2002;61:534–7.

    Article  PubMed  CAS  Google Scholar 

  23. Li CA, Kim HO, Lee SY, Lee SI. Assessment of Achilles enthesitis in the spondyloarthropathies by colour Doppler energy ultrasound in the context of the ‘enthesis organ. Scand J Rheumatol. 2010;39:141–7.

    Article  PubMed  CAS  Google Scholar 

  24. Balint PV, Kane D, Wilson H, et al. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002;61:905–10.

    Article  PubMed  CAS  Google Scholar 

  25. de Miguel E, Cobo T, Munoz-Fernandez S, et al. Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis. 2009;68:169–74.

    Article  PubMed  Google Scholar 

  26. De Filippis LG, Caliri A, Lo Gullo R, et al. Ultrasonography in the early diagnosis of psoriasis-associated enthesopathy. Int J Tissue React. 2005;27:159–62.

    PubMed  Google Scholar 

  27. Klauser AS, Wipfler E, Dejaco C, et al. Diagnostic values of history and clinical examination to predict ultrasound signs of chronic and acute enthesitis. Clin Exp Rheumatol. 2008;26:548–53.

    PubMed  CAS  Google Scholar 

  28. Kiris A, Kaya A, Ozgocmen S, Kocakoc E. Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography. Skeletal Radiol. 2006;35:522–8.

    Article  PubMed  Google Scholar 

  29. Falsetti P, Acciai C, Lenzi L, Frediani B. Ultrasound of enthesopathy in rheumatic diseases. Mod Rheumatol. 2009;19:103–13.

    Article  PubMed  Google Scholar 

  30. Falsetti P, Frediani B, Filippou G, et al. Enthesitis of proximal insertion of the deltoid in the course of seronegative spondyloarthritis. An atypical enthesitis that can mime impingement syndrome. Scand J Rheumatol. 2002;31:158–62.

    PubMed  Google Scholar 

  31. Lambert RG, Dhillon SS, Jhangri GS, et al. High prevalence of symptomatic enthesopathy of the shoulder in ankylosing spondylitis: deltoid origin involvement constitutes a hallmark of disease. Arthritis Rheum. 2004;51:681–90.

    Article  PubMed  Google Scholar 

  32. Frediani B, Falsetti P, Storri L, et al. Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol. 2002;21:203–6.

    Article  PubMed  Google Scholar 

  33. Delle Sedie A, Riente L, Filippucci E, et al. Ultrasound imaging for the rheumatologist XXVI. Sonographic assessment of the knee in patients with psoriatic arthritis. Clin Exp Rheumatol. 2010;28:147–52.

    PubMed  CAS  Google Scholar 

  34. Scarpa R, Atteno M, Costa L, et al. Early psoriatic arthritis. J Rheumatol. 2009;83:26–7.

    Google Scholar 

  35. Scarpa R, Cuocolo A, Peluso R, et al. Early psoriatic arthritis: the clinical spectrum. J Rheumatol. 2008;35:137–41.

    PubMed  Google Scholar 

  36. Gutierrez M, Filippucci E, De Angelis R, et al. Subclinical entheseal involvement in patients with psoriasis: an ultrasound study. Semin Arthritis Rheum. 2011;40:407–12.

    Article  PubMed  Google Scholar 

  37. Ozcakar L, Cetin A, Inanici F, et al. Ultrasonographical evaluation of the Achilles’ tendon in psoriasis patients. In: 2005. p. 930–2.

  38. McGonagle D, Wakefield RJ, Tan AL, et al. Distinct topography of erosion and new bone formation in achilles tendon enthesitis: implications for understanding the link between inflammation and bone formation in spondylarthritis. Arthritis Rheum. 2008;58:2694–9.

    Article  PubMed  Google Scholar 

  39. Benjamin M, Toumi H, Suzuki D, et al. Evidence for a distinctive pattern of bone formation in enthesophytes. Ann Rheum Dis. 2009;68:1003–10.

    Article  PubMed  CAS  Google Scholar 

  40. Girolomoni G, Gisondi P. Psoriasis and systemic inflammation: underdiagnosed enthesopathy. J Eur Acad Dermatol Venereol. 2009;23:3–8.

    Article  PubMed  Google Scholar 

  41. Lehtinen A, Leirisalo-Repo M, Taavitsainen M. Persistence of enthesopathic changes in patients with spondylarthropathy during a 6-month follow-up. Clin Exp Rheumatol. 1995;13:733–6.

    PubMed  CAS  Google Scholar 

  42. Genc H, Duyur Cakit B, Nacir B, et al. The effects of sulfasalazine treatment on enthesal abnormalities of inflammatory rheumatic diseases. Clin Rheumatol. 2006;26:1104–10.

    Article  PubMed  Google Scholar 

  43. D’Agostino MA, Breban M, Said-Nahal R, Dougados M. Refractory inflammatory heel pain in spondylarthropathy: a significant response to infliximab documented by ultrasound. Arthritis Rheum. 2002;46:840–1. author reply 841–3.

    Article  PubMed  Google Scholar 

  44. •• Naredo E, Batlle-Gualda E, GarcÃA-Vivar ML, et al. Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. The J Rheumatol. 2010;37:2110–17. This study reported results of an open-label cohort study of spondyloarthritis patients treated with anti–tumor necrosis factor agents and followed clinically with sonography over 6 months.

    Article  PubMed  Google Scholar 

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Disclosure

Dr. Kaeley’s institution has received honoraria from SonoSite and Esaote for unrestricted equipment loans.

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Correspondence to Gurjit Singh Kaeley.

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Kaeley, G.S. Review of the Use of Ultrasound for the Diagnosis and Monitoring of Enthesitis in Psoriatic Arthritis. Curr Rheumatol Rep 13, 338–345 (2011). https://doi.org/10.1007/s11926-011-0184-8

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  • DOI: https://doi.org/10.1007/s11926-011-0184-8

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