Subclinical Inflammation in Psoriatic Patients with No History of Psoriatic Arthritis: An Assessment By Magnetic Resonance Imaging

David Simon¹, Francesca Faustini¹, Matthias Englbrecht¹, Arnd Kleyer¹, Roland Kocijan², Judith Haschka³, Sebastian Kraus³, Axel J. Hueber¹, Michael Sticherling⁴, Georg Schett¹ and Jürgen Rech³, ¹Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany, ²Medical Department II, St. Vincent Hospital, Vienna, Austria, ³Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ⁴Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Imaging, psoriasis and psoriatic arthritis

Session Information

Title: Imaging of Rheumatic Diseases: Magnetic Resonance Imaging (MRI)

Session Type: Abstract Submissions (ACR)

Background/Purpose Six to 39% of patients with cutaneous psoriasis (PSO) can develop psoriatic arthritis (PsA). The transition from skin disease to joint involvement is only partially characterized. Advanced imaging can depict signs of subclinical joint involvement. The present study analyzes the prevalence of hand-MRI signs of inflammation in PSO patients without clinical history of synovitis, dactylitis and enthesitis and no positive CASPAR criteria at any time, but evidence of bone proliferative changes on high resolution peripheral computed tomography (HR-pQCT) of the dominant hand.

Methods

PSO patients underwent HR-pQCT (Scanco Medical, Switzerland) and 1.5T MRI (Siemens, Germany) of the dominant hand. HR-pQCT focused on the metacarpophalangeal (MCP) joints 2 and 3. Imaging analysis searched for erosions and new bone formation (bony spurs) with a periarticular location. MRI of the whole hand was conducted to detect osteitis, synovitis, tenosynovitis of the flexor tendon, periarticular inflammation at the MCP, PIP and DIP regions of the 2nd to 5th finger, according to the definitions of key pathologies provided for the PsAMRIS scoring system. Patients participated after signing informed consent. The study was conducted upon approval by the local ethic committee and the National Radiation Safety Agency (BfS).

Results

Images were acquired from 55 PSO patients (36.4% female) of mean age 49.5±11.5 y, mean disease duration 15.2±15.4 y and mean PASI score of 6.2±8.0. The most prevalent subtype was psoriasis vulgaris (73%), while nail psoriasis was present in 51 % and scalp involvement in 29%. On HR-pQCT erosions were found in 29% of patients, while all showed new bone formation. On MRI, 26 patients (47%) showed at list one of the mentioned signs of MRI detectable inflammation. In detail, osteitis was found in 6 patients (11%), while synovitis in 21 (38%); tenosynovitis and periarticular inflammation were detected each in 2 patients (4%). In the total sample, partial correlations (controlling for the influence of age and disease duration) between periarticular bone changes observed on HRp-QCT and osteitis as well as synovitis on MRI did not show any significant relations.

Conclusion

MRI signs of inflammation can be found in patients with cutaneous psoriasis without a history of arthritis. No evident relation seems to link these signs to bony changes observed on HR-pQCT. Longitudinal assessment of inflammation might provide deeper insight into the relationship between inflammation and changes in bone microstructure before the onset of clinical signs of arthritis.

Disclosure:

D. Simon,
None;

F. Faustini,
None;

M. Englbrecht,
None;

A. Kleyer,
None;

R. Kocijan,
None;

J. Haschka,
None;

S. Kraus,
None;

A. J. Hueber,
None;

M. Sticherling,
None;

G. Schett,
None;

J. Rech,
None.

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