Background/Purpose: Psoriasis is a diseases with diverse skeletal manifestations of which enthesistis is the primary lesion. However, enthesitis may often develop without any symptoms or signs. The primary objective of this study is to evaluate presence of subclinical enthesitis with ultrasonography in patients with psoriasis without any clinical findings of arthritis and/or enthisitis. Secondary objective is to compare ultrasonographic findings with clinical severity of psoriasis and enthesitis.

Methods: 30 patients with psoriasis without clinical findings of arthritis or enthesitis and 30 healthy volunteers as a control group were involved in the study. In the patient group PASI (Psoriasis Area and Severity Index), NAPSI (Nail Psoriasis Severity Index), MASES (Maastricht Ankylosing Spondylitis Entheses Score) and SPARCC (Spondyloarthritis Research Consortium of Canada); in the control group MASES and SPARCC scores were calculated. An investigator blind to clinical scores performed ultrasonographic examination on SPARCC scoring sites: bilateral achilles tendon, calcaneal insertion of the plantar fascia, patellar tendon insertion at the base of patella, quadriceps tendon insertion of the upper edge of the patella, trochanter major, supraspinatus tendon insertion at great tuberosity of humerus, medial epicondyle and lateral epicondyle. Acute, chronic and total enthesitis scores were calculated as described in literatures (1,2).

Results: In the patient group the total enthesitis score was significantly higher than the control group.(4.70±3.54SD in the patient group vs 2.90±2.36SD in the control group, p=0.04) There were no significant differences in the acute enthesitis score and chronic enthesitis scores between the groups.(acute enthesitis score the 0.83±1.08SD in the patient group vs 0.37±0.71 in the control group, p= 0.05; chronic enthesitis score 3.87±3.20SD in the patient group vs 2.53±2.09SD in the control group, p=0.14) There was no significant relationship between NAPSI, PASI, MASES, SPARCC scores and the ultrasonographic enthesitis scores in the patient group. In the patient group, there was a low level of statistically significant correlation between MASES and SPARCC scores.(r=0.38 p=0.03) There was no correlation between any of the other clinical scores.

Conclusion: Entheseal changes are common in clinically asymptomatic patients with psoriasis. Ultrasound may be useful in early detection of enthesitis. Reference:

1. Kaeley GS. Review of the use of ultrasound for the diagnosis and monitoring of enthesitis in psoriatic arthritis. Curr Rheumatol Rep. 2011;13(4):338-345.
2. Hamdi W, Chelli-Bouaziz M, Ahmed MS, et al. Correlations among clinical, radiographic, and sonographic scores for enthesitis in ankylosing spondylitis. Joint Bone Spine. 2011;78(3):270-274. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-evaluation-of-subclinical-enthesitis-in-patients-with-psoriasis/