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An Update on Imaging in PsA

June 16 2017 12:20 PM ET via RheumReports RheumReports

Prof. Ostergaard presented an excellent overview of the current knowledge about the utility of ultrasound and MRI in PsA. A few key points to remember:

  • In addition to bone damage (e.g. erosions and bone formation), ultrasound and MRI can assess active inflammatory lesions typical of PsA such as synovitis, enthesitis, and tenosynovitis. Ultrasound is as accurate as MRI in assessing these lesions except for bone edema, which can only be evaluated by MRI.

  • Similar to RA, these modalities are much more sensitive than physical examination in detecting active musculoskeletal inflammation in PsA.

  • Subclinical inflammation, particularly enthesitis and synovitis, are frequently found in patients with psoriasis who do not have clinical arthritis. A recent study found that approximately half of the patients with psoriasis assessed by MRI of the hands had evidence of synovitis. Among these patients, the combination of synovitis by MRI and joint pain was associated with approximately a 4-fold increase in the risk of developing future clinical PsA.

  • There is much less data on the value of imaging in patients with established PsA compared with RA. It appears that similar to RA, the presence of bone edema is predictive of the development of joint erosions. Among patients with early PsA, the presence of persistent inflammation by ultrasound predicted the development of radiographic damage by 12 months.

  • Could ultrasound assist in decisions to taper off medications? In a prospective study that assessed the predictive value of ultrasound in patients with PsA who were in clinical remission and stopped their DMARDs, the presence of synovial hypertrophy trended towards being associated with a higher risk of disease flare. So currently it is not clear if ultrasound could assist with this decision.

  • Whole body MRI remains an experimental tool. The main advantage is its ability to assess disease activity in multiple domains and sites typical of PsA (e.g. enthesitis, arthritis). Its validity is currently being tested.


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About the Author

Dr. Lihi Eder
Dr. Lihi Eder

Dr. Lihi Eder is an Assistant Professor of Medicine at the University of Toronto and Staff Rheumatologist and Director of the Psoriatic Arthritis Research Program at Women’s College Hospital. Dr. Eder is a Scientist at Women’s College Research Institute and associate member of the graduate faculty at the Institute of Medical Science.

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