Ultrasound and Magnetic Resonance Imaging Evaluation of the Fingers’ Joints of Psoriatic Arthritis Patients

Ari Polachek¹, Victoria Furer ², Mirna Zureik ², Sharon Nevo ², Liran Mendel ², David Levartovsky ³, Jonathan Wollman ⁴, Valerie Aloush ⁵, Mark Berman ⁶, Ilana Kaufman ⁶, Yael Lahat ², Hagit Sarbagil-Maman ⁷, Sara Borok ⁶, Adi Broyde ⁶, Lihi Eder ⁸, Daphna Paran ¹, Iris Eshed ⁹ and Ori Elkayam ¹⁰, ¹Tel-Aviv Sourasky medical center, Tel Aviv, Israel, ²Sourasky Medical Center, Tel-Aviv, Israel, ³Sourasky medical center, Tel Aviv, Israel, ⁴Sourasky Medical Center, Herzelia, Israel, ⁵Tel Aviv Sourasky medical center, Tel Aviv, ⁶Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, ⁷Tel-Aviv Sourasky medical center, Qiryat-Ono, Israel, ⁸Women’s College Hospital and the Department of Medicine, University of Toronto, Toronto, Canada, ⁹Sheba Medical Center, Tel-Aviv, Israel, ¹⁰Rheumatology Department, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel., Tel Aviv, Israel

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Disease Activity and joints, Doppler ultrasound, Imaging, Magnetic resonance imaging (MRI)

Session Information

Date: Sunday, November 10, 2019

Session Title: Imaging Of Rheumatic Diseases Poster I

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Psoriatic arthritis (PsA) is an inflammatory disease affecting up to 30% of psoriasis patients. PsA can involve both the peripheral and axial skeleton and manifest with inflammatory and structural changes such as synovitis, tenosynovitis and erosions. Ultrasound (US) and magnetic resonance imaging (MRI) are the leading imaging modalities for peripheral arthritis assessment. However, little is known about the discrepancies between these two modalities in PsA patients. The aim of the study was to evaluate the agreement between US and MRI in the detection of fingers lesions in PsA patients and to evaluate the sensitivity and specificity of US with MRI as gold standard.

Methods: Consecutive PsA patients (all fulfilled the CASPAR criteria) were recruited prospectively. All patients underwent US and MRI assessment of MCP, PIP and DIP joints of one matched hand. The time interval between US and MRI scans was at most 3 days and the US and MRI assessors were blinded to the clinical data. NSAIDs treatment was hold for 3 days before assessment. Agreement between MRI and US was calculated based on absolute agreement and Cohen’s Kappa values. Sensitivity and specificity of US was evaluated with MRI as gold standard.

Results: Sixty PsA patients with mean age of 52 years (± 12.9) and female:male ratio of 60%:40% were included (Table 1). Three hundred MCP, 300 PIP and 240 DIP were assessed by US and MRI. The prevalence of synovitis, flexor tenosynivitis and erosions were comparable between the US and MRI assessments (Table 2). Synovitis (19.3% for US and 13.7% for MRI) and flexor tenosynovitis (5.7% for US and 6.3% for MRI) were more prevalent in the MCP joints compared to the PIP and DIP joints in both modalities. Absolute agreement and kappa values between US and MRI were 84%-95% with moderate to substantial kappa values (0.411-0.654), 94%-97% with fair to moderate kappa values for tenosynovitis (0.208-0.468) and 98% with fair to moderate kappa values for erosions (0.211 to 0.492) (Table 3). The sensitivity and specificity of US with MRI for synovitis ranged between 0.5-0.78 and 0.87-0.97 according to the specific type of joint (DIP, PIP and MCP), and for flexor tenosynovitis 0.25-0.47 and 0.97, respectively.

Conclusion: US and MRI have moderate to good agreement for the detection of inflammatory and destructive changes, while the sensitivity is better for synovitis compared to flexor tenoseynovitis.

Table 1. Baseline characteristics

Table 1. Baseline characteristics -60 patients with matched scanned hand-

Table 2. Prevalence of lesions

Table 2. Prevalence of lesions for each group of joints

Table 3. Absolute agreement and Kappa values

Table 3. Agreement and Kappa values between US and MRI

Disclosure: A. Polachek, None; V. Furer, None; M. Zureik, None; S. Nevo, None; L. Mendel, None; D. Levartovsky, None; J. Wollman, None; V. Aloush, None; M. Berman, None; I. Kaufman, None; Y. Lahat, None; H. Sarbagil-Maman, None; S. Borok, None; A. Broyde, None; L. Eder, Abbvie, 2, 5, 8, Celgene, 5, Janssen, 5, Lily, 2, 5, Novartis, 2, 5, Pfizer, 2, 8, UCB, 2; D. Paran, None; I. Eshed, None; O. Elkayam, Pfizer, 2, 5, 8.

To cite this abstract in AMA style:

Polachek A, Furer V, Zureik M, Nevo S, Mendel L, Levartovsky D, Wollman J, Aloush V, Berman M, Kaufman I, Lahat Y, Sarbagil-Maman H, Borok S, Broyde A, Eder L, Paran D, Eshed I, Elkayam O. Ultrasound and Magnetic Resonance Imaging Evaluation of the Fingers’ Joints of Psoriatic Arthritis Patients – Interim Analysis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/ultrasound-and-magnetic-resonance-imaging-evaluation-of-the-fingers-joints-of-psoriatic-arthritis-patients-interim-analysis/. Accessed May 29, 2020.

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