Session Title: Imaging of Rheumatic Diseases: Various Imaging Techniques
Session Type: Abstract Submissions (ACR)
Psoriasis (PSO) is a frequent disease which affects about 1-2% of the population and can be associated to arthritis (PsA). Skin disease often predates the onset of PsA and the transition from skin to joint pathology has been not yet fully elucidated. PsA bone changes include erosions and new bone formation. Aim of the present study was to investigate whether patients with PSO, without clinical history of synovitis, dactylitis or enthesitis at any time and no fulfillment of CASPAR criteria show early changes of the periarticular bone that are typical of PsA.
PSO patients and healthy subjects (HS) underwent HR-pQCT (XtremeCT, Scanco Medical, Switzerland) scans of the dominant hand which focused on the metacarpal head and phalangeal base of the MCP joints 2 and 3. Erosions, defined as cortical breaks within the joint and visible in two planes, were assessed by frequency and volume (mm3). Bony spurs, defined as bony projections emerging from the cortical shell and located in the periarticular region were assessed by frequency and maximal height (mm) i.e. the distance between the highest surface of the lesion and the original cortical surface). 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 (mean age 49.5±11.5 y, 36.4% females) and 47 HS (mean age 45.8±13.0 y, 48.9% females). Mean age and sex distribution were comparable. PSO patients had mean disease duration of 15.2±15.4 y, a mean PASI score of 6.2±8.0, while the most prevalent subtype was psoriasis vulgaris (73%). Nail psoriasis was present in 51 % and scalp involvement in 29%. Erosions were identified in PSO and HS (27 vs 18). The most frequent location of the erosions was the radial aspect of the metacarpal head 2 in both groups. The volume of the erosion was not significantly different between the groups. An average number of 6 bony spurs was found in the PSO patients while this accounted for 3 in the HS (total number 306 vs 138). A similar trend of distribution of bony spurs was found in both groups with the majority of them locating in the metacarpal head 2 (palmar and dorsal aspect). PSO patients showed larger bony spurs compared to the HS in each region of interest. For the metacarpal head 2 the mean size accounted for 1.7±0.8 vs. 1.2±0.5 mm respectively, p=0.001; metacarpal head 3: 1.2±0.6 and 0.8±0.3 mm, p=0.001. In the phalangeal base 2 the PSO patients showed a mean size of 1.3±0.7 mm, and the HS of 0.7±0.3 mm, p<0.001. In the phalangeal base 3 mean values accounted for 1.2±0.7 mm and 0.8±0.2 respectively, p=0.003.
Analysis of the bone microstructure indicates that patients with PSO without PsA show more pronounced anabolic changes than healthy subjects. Periarticular new bone formation could be an early expression of altered bone remodeling previous to the onset of PsA.
A. J. Hueber,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bone-microstructure-in-patients-with-cutaneous-psoriasis-and-no-history-of-psoriatic-arthritis-shows-bone-anabolic-changes-at-a-greater-extent-than-in-healthy-controls/