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Open Access Highly Accessed Research article

Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

Charlotte Wiell1*, Marcin Szkudlarek1, Maria Hasselquist2, Jakob M Møller2, Aage Vestergaard3, Jesper Nørregaard4, Lene Terslev5 and Mikkel Østergaard15

Author Affiliations

1 Department of Rheumatology, University of Copenhagen Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark

2 Department of Diagnostic Radiology, University of Copenhagen Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark

3 Department of Radiology, University of Copenhagen Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark

4 Department of Rheumatology, University of Copenhagen Nordsjællands Hørsholm Hospital, Usserød Kongevej 102, 2970 Hørsholm, Denmark

5 Department of Rheumatology, University of Copenhagen Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark

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Arthritis Research & Therapy 2007, 9:R119  doi:10.1186/ar2327

Published: 14 November 2007

Abstract

The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd–5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP] joints, and distal interphalangeal [DIP] joints) and 1st–5th metatarsophalangeal joints of both hands and feet were assessed with US for the presence of synovitis, bone erosions, bone proliferations, and capsular/extracapsular power Doppler signal (only in the PIP joints). The 2nd–5th flexor and extensor tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer. US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high absolute agreement (85% to 100%) for all destructive changes and a more moderate absolute agreement (73% to 100%) for the inflammatory pathologies were found between US and MRI. US detected a higher frequency of DIP joint changes in the PsA patients compared with RA patients. In particular, bone changes were found exclusively in PsA DIP joints. Furthermore, bone proliferations were more common and tenosynovitis was less frequent in PsA than RA. For other pathologies, no disease-specific pattern was observed. US and MRI have major potential for improved examination of joints, tendons, and entheses in fingers and toes of patients with PsA.