Psoriatic arthritis: early ultrasound findings Poster No.: C-0399 Congress: ECR 2014 Type: Educational Exhibit Authors: R. Persechino 1, L. Cristiano 1, A. Bartoloni 1, C. Cantone 2, A. Keywords: DOI: Costanzo 1, G. Argento 1 ; 1 Rome/IT, 2 Roma/IT Arthritides, Normal variants, Ultrasound-Colour Doppler, Ultrasound, Musculoskeletal joint 10.1594/ecr2014/C-0399 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 6
Learning objectives Psoriatic arthritis is a type of arthritic inflammation that occurs in about 30 percent of patients who have a skin rash called psoriasis. This particular arthritis can affect any joint in the body, and symptoms vary from person to person. Research has shown that persistent inflammation from psoriatic arthritis can lead to joint damage. Fortunately, available treatments are effective for most people. Psoriatic arthritis can affect any joint in the body, and it may affect just one joint, several joints or multiple joints. For example, it may affect one or both knees. Affected fingers and toes can resemble swollen sausages, a condition often referred to as dactylitis. Finger and toe nails also may be affected. Psoriatic arthritis also can cause tender spots where tendons and ligaments join onto bones. This condition, called enthesitis, can result in pain at the back of the heel, the sole of the foot, around the elbows or in other areas. Enthesitis is one of the characteristic features of psoriatic arthritis. Recent research suggests that persistent inflammation from psoriatic arthritis causes joint damage later, so early accurate diagnosis is essential. Fortunately, treatments are available and effective for most people. Background Based on a case series of 132 patients, evaluated with ultrasound, our work aims to describe three different modes of onset of psoriatic arthritis and the sonographic features Findings and procedure details -Acute to chronic bursitis are easily identified on ultrasound, which allows a clear internal structure visualization of walls. Bursitis causes pain and tenderness around the affected bone or tendon. The bursae sacs may swell, often making movement difficult. The most commonly affected joints are the shoulder, elbow, knee, and foot. -The enthesitis and tenosynovitis, common in all forms of psoriatic arthritis, sonographically assessed through dinamic examinations Page 2 of 6
The enthesitis and tenosynovitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone.it is also called enthesopathy, or any pathologic condition involving the entheses. The entheses are any point of attachment of skeletal muscles to the bone, where recurring stress or inflammatory autoimmune disease can cause inflammation or occasionally fibrosis and calcification. One of the primary entheses involved in inflammatory autoimmune disease is at the heel, particularly the Achilles tendon. -Dactylitis can occur in seronegative arthropathies, such as psoriatic arthritis and ankylosing spondylitis, in sickle-cell disease as result of a vasoocclusive crisis with bone infarcts, and in infectious conditions including tuberculosis and leprosy. Dactylitis is often associated with intra-articular or subchondral bone erosions perfectly evaluated by ultrasound. Images for this section: Fig. 1: Olecranon bursitis: hypoechoic area with septa in the context iperecoeni Page 3 of 6
Fig. 2: Insertional tendinopathy of the triceps brachii (axial scan) that is increased in thickness with calcifications in the context Fig. 3: Thickening and inhomogeneous hypoechoic of the conjoined tendon of the extensor stretch pre-insertional humeral epicondyle: tendinopathyenthesopathyinflammatory Page 4 of 6
Fig. 4: Payments to load the proximal interphalangeal joint (arrow) with subchondral bone erosions (circle) identified as interruption of the cortical bone Fig. 5: Thickening of the synovial sheath of the flexor tendon of the finger that appears vascular color-doppler examination Page 5 of 6
Conclusion Therefore, the ultrasonography is a dynamic, non-invasive and low-cost instrument for the study of enthesis, tendon sheaths, and intra-articular synovial pannus.psoriatic arthritis presents multiple clinical manifestations ; therefore must not exclude the presence of disease, in the case where is observed, in addition to joint symptoms associated with seronegative laboratory examinations and the presence of mild cutaneous manifestations. Personal information References Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease. McGonagleD.. JEurAcadDermatolVenereol. 2009 Sep;23Suppl1:9-13 Page 6 of 6