الفهرس 
Introduction
PsoriasisOnly 14 pages are availabe for public view
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Abstract
Psoriatic arthritis (PsA) belongs to the groupof seronegativespondyloarthropathies and ischaracterised by inflammation of joints, tendons,and/or entheses associated with psoriatic skinand/or nail lesions (Gisondi et al, 2010; Wollina et al, 2010). Clinical presentation and clinicalcourse are highly variable, ranging from subtlepain at joints and tendon insertions to mutilating arthritis,from monoarthritis to polyarticularrheumatoid arthritis (RA)-like phenotype, or from mild spinalinflammation to frank ankylosing spondylitis (Coates et al, 2012).
AsPsA usually arises in patients with preexistingpsoriasis, clinicians have the unique opportunityto screen a defined population (namely patientswith psoriasis) in order to identify arthritic patientsat an early stage (Anandarajah and Ritchlin, 2009; Husic et al, 2014).
The severity of articular inflammationmay be clinically underestimated (Scarpa et al, 2008) and unfortunately, there are no specific laboratorymarkers for the disease, and conventionalradiography is of limited value for early diagnosis (Anandarajah and Ritchlin, 2009; Wollina et al, 2010; Sankowski et al, 2013(a); Sankowski et al, 2013(b)).
Inflammatory lesions in the early stages of the disease involve synovial membrane and periarticular tis¬sues. By using conventional radiography these lesions often remain unrevealed, whereas they can be effectively visual¬ized by ultrasonography and magnetic resonance imaging. These facts point to a higher efficacy of ultrasound and MR imaging in the assessment of soft tissues (de Simone et al, 2011; Wittoek et al, 2011).
Magnetic resonanceimaging (MRI) and musculoskeletal ultrasound (MSUS)are new attractive tools supporting diagnostic andmanagement decisions in PsA(Schirmer et al, 2011; Coates et al, 2012). They enable the assessment and monitoring of early inflammatory changes. As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided (Sankowski et al, 2013(a)).
Musculoskeletal ultraonography hasthe advantage over MRI of being widely available,immediately available at the bedside,having no contraindications, a higher resolution,and with lower costs. On the other hand,some anatomical locations cannot be judged, andintraosseous lesions, such as bone marrow oedema,cannot be detected by ultrasonography, and an experienced examiner is necessary to perform the examination and evaluate the findings (Backhaus et al, 1999; Schirmer et al, 2011; Husic et al, 2014).
This study aimed to determine the diagnostic efficacy of MSUS and MRI in the detection of subclinical involvement of hands and feet in patients with plaque psoriasis (without clinical or radiolographic evidence of PsA), and to compare the MSUS findings with those of MRI.Also, we searched for any predictor risk factorsamong demographic, clinical and laboratory variables for the presence ofPsA.
Thirty Patients with plaque psoriasis with no clinical or radiological signs of arthritis attending outpatient dermatology clinic of Assiut University Hospitals were enrolled in the study. All patients underwent clinical examination (including dermatological and rheumatological examination), MSUS, MRI, X-ray evaluation of the hands and feet joints, and Achilles tendons.
We found that both MSUS and MRI were sensitive in detecting subclinical joint inflammation (synovitis), and bone abnormalities (bone erosions, bone proliferations, bone marrow edema) in psoriatic patients with normal conventional radiographs.
Of the total examined joints of hands and feet (2520), synovitis was detected by MSUS in 597 joints (23.69%), erosions in 228 joints (9.04%), and bone proliferation in 558 joints (22.14%). Meanwhile, MRI detected synovitis in 399 joints (15.83%), erosions in 19 joints (0.75%), and bone marrow edema in 34 joints (1.35%).
As regard Achilles tendon evaluation, we detected increased thickness in 3.33% of cases, enthesophytes at right Achilles tendon in 16.6% of cases and in 20.0% of cases in the left Achilles tendon. Bone marrow edema was detected only by MRI in the calcaneus bone in 3.33% of cases.
It was significantfinding that among the demographic, clinical and laboratory variables, theonly predictor factor of subclinical PsAwas the presence of nail psoriatic involvement. A significant correlation was found between the subclinical psoriatic arthritis detected by MSUS with the presence of nail psoriasis especially in the DIP joint.
Conclusion
Results from the present study and the studies presented in this thesisdocument that clinically asymptomatic patients with psoriasis may exhibit subclinical inflammatory and destructive joints and enthesealchanges.
Since clinical examination fails to detect subclinical arthropathies or enthesopathies, ultrasonography and MRI proved to be useful, and more accurate than conventional radiography for identifying such abnormalities early in the course of the disease.
Musculoskeletal ultrasonography is superior over MRI as an effective diagnostic imaging approachfor documenting subclinical PsA.
There is a significant correlation between the presence of nail psoriasis and subclinical PsA, mainly DIP arthritis.