Background/Purpose: Between 8-39% of patients with cutaneous psoriasis may develop psoriatic arthritis (PsA). Subclinical inflammatory joint disease in patients with psoriasis is common. ^i,ii This study sought to examine the utility of easily accessible office-based eMRI in evaluating inflammation and damage in a subset of psoriasis patients without arthritis, and compare the findings with PsA patients.

Methods: Psoriasis patients recruited from Dermatology and Rheumatology clinics of a tertiary care, teaching institution in southern India were divided into those without arthritis (PsO) and PsA groups. All underwent contrast eMRI of the dominant or most-affected hand. Demographic and physical examination details were noted. PsO patients completed the early arthritis in psoriasis (EARP) questionnaire. MRIs were scored by two trained readers, based on Psoriatic arthritis MRI score (PsAMRIS). One reader (AJM) read all studies and a second reader (JP) read a random subset of 40 cases to assess inter-reader reliability. Reliability of scores was determined using intra-class correlation coefficient. Proportion of patients showing any signs of MRI inflammation (synovitis, osteitis, tenosynovitis, periarticular inflammation) or damage (erosion or bone proliferation) was determined. Mann-Whitney U test was used to compare PsA with PsO patients. Significant values (p<0.1) were included in multivariate linear regression to assess their independent contributions to outcome.

Results: 104 patients included 62 PsO and 42 PsA, with 73% males; mean age was 42.08±11.90 years. Inter-reader reliability for all features was very good (ICC >0.7). Thirty-nine (62%) patients in the PsO group exhibited evidence of inflammation and 31 (60%) patients showed evidence of damage by eMRI (Table 1). Flexor tenosynovitis and periarticular inflammation were the most common pathologies identified. PsO patients with nail involvement showed a higher percentage of cases with MRI inflammation (p = 0.037). EARP ≥3 (OR 1.9; p = 0.024) in PsO group and NAPSI scores ≥20 in PsA group predicted higher MRI inflammation.

Conclusion: This study demonstrates a high proportion of psoriasis patients with subclinical disease and evidence of joint damage. Patients with psoriasis and nail involvement had a higher risk of subclinical disease. Office eMRI provides a potential screening tool for these at-risk groups. ⁱ  Freeston JE et al. Arthritis Care Res (Hoboken) 2014;66:432-9 ⁱⁱ  Faustini F et al. Ann Rheum Dis doi:10.1136/annrheumdis-2015-208821 Table 1:  PsAMRIS variables for MRI inflammation and damage in the PsO and PsA subgroups

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utility-of-extremity-magnetic-resonance-imaging-emri-without-contrast-enhancement-in-detecting-preclinical-psoriatic-arthritis/