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MRI in psoriatic arthritis: Insights into pathogenesis and treatment response

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Abstract

Psoriatic arthritis (PsA) is a clinically heterogeneous condition, and not surprisingly, its MRI features are diverse. Synovitis and accompanying synovial effusions are clearly depicted, and enthesitis is characterized by extracapsular inflammation at the insertions of ligaments and tendons plus accompanying bone edema at bony attachments. Other forms of MRI bone edema include subchondral and diaphyseal involvement; the latter seeming relatively specific to PsA. The pathology of dactylitis can also be elucidated by MRI, which frequently reveals tenosynovitis and soft tissue edema in conjunction with various degrees of synovitis, bone edema, and erosion. Bone erosions differ from those seen in rheumatoid arthritis in their distribution and associated features such as bone proliferation and sometimes periostitis. Finally, MRI can be used to score and quantify these pathologic features, providing a sensitive tool with which to evaluate disease progression.

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References and Recommended Reading

  1. Wright V: Psoriasis and arthritis. Ann Rheum Dis 1956, 15: 348–356.

    Article  PubMed  CAS  Google Scholar 

  2. Peterfy CG: Magnetic resonance imaging of the wrist in rheumatoid arthritis. Semin Musculoskelet Radiol 2001, 5: 275–288.

    Article  PubMed  CAS  Google Scholar 

  3. Veale D, Yanni G, Rogers S, et al.: Reduced synovial membrane macrophage numbers, ELAM-1 expression, and lining layer hyperplasia in psoriatic arthritis as compared with rheumatoid arthritis. Arthritis Rheum 1993, 36: 893–900.

    Article  PubMed  CAS  Google Scholar 

  4. van Kuijk AWR, Reinders-Blankert P, Smeets TJM, et al.: Detailed analysis of the cell infiltrate and the expression of mediators of synovial inflammation and joint destruction in the synovium of patients with psoriatic arthritis: implications for treatment. Ann Rheum Dis 2006, 65: 1551–1557.

    Article  PubMed  Google Scholar 

  5. McQueen F, Lassere M, Ostergaard M: Magnetic resonance imaging in psoriatic arthritis: a review of the literature. Arthritis Res Ther 2006, 8: 207.

    Article  PubMed  Google Scholar 

  6. Konig H, Sieper J, Wolf KJ: Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology 1990, 176: 473–477.

    PubMed  CAS  Google Scholar 

  7. Cimmino MA, Parodi M, Innocenti S, et al.: Dynamic magnetic resonance of the wrist in psoriatic arthritis reveals imaging patterns similar to those of rheumatoid arthritis. Arthritis Res Ther 2005, 7: R725–731.

    Article  PubMed  Google Scholar 

  8. Savnik A, Bliddal H, Nyengaard JR, Thomsen HS: MRI of the arthritic finger joints: synovial membrane volume determination, a manual vs a stereologic method. Eur Radiol 2002, 12: 94–98.

    Article  PubMed  Google Scholar 

  9. Ghanem N, Uhl M, Pache G, et al.: MRI in psoriatic arthritis with hand and foot involvement. Rheumatol Int 2007, 27: 387–393.

    Article  PubMed  Google Scholar 

  10. Tan AL, Grainger AJ, Tanner SF, et al.: A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum 2006, 54: 1328–1333.

    Article  PubMed  Google Scholar 

  11. Scarpa R, Soscia E, Peluso R, et al.: Nail and distal interphalangeal joint in psoriatic arthritis. J Rheumatol 2006, 33: 1315–1319.

    PubMed  Google Scholar 

  12. Schoellnast H, Deutschmann HA, Hermann J, et al.: Psoriatic arthritis and rheumatoid arthritis: findings in contrast-enhanced MRI. AJR Am J Roentgenol 2006, 187: 351–357.

    Article  PubMed  Google Scholar 

  13. Narvaez J, Narvaez JA, Nolla JM: Comparative study of MR imaging findings in wrist and hands in early psoriatic arthritis and rheumatoid arthritis. Arthritis Rheum 2007, 56: S281.

    Google Scholar 

  14. Antoni C, Manger B: Infliximab for psoriasis and psoriatic arthritis. Clin Exp Rheumatol 2002, 20(6 Suppl 28): S122–S125.

    PubMed  CAS  Google Scholar 

  15. Anandarajah AP, Ory R, Salonen D, et al.: The effect of adalimumab on clinical and MRI outcome measures in psoriatic arthritis. Arthritis Rheum 2007, 56: S156.

    Google Scholar 

  16. Marzo-Ortega H, McGonagle D, Rhodes LA, et al.: Efficacy of infliximab on MRI determined bone oedema in psoriatic arthritis. Ann Rheum Dis 2006, 66: 778–781.

    Article  PubMed  Google Scholar 

  17. Cowper SE, Kuo PH, Bucala R: Nephrogenic systemic fibrosis and gadolinium exposure: association and lessons for idiopathic fibrosing disorders [comment]. Arthritis Rheum 2007, 56: 3173–3175.

    Article  PubMed  CAS  Google Scholar 

  18. Alenius GM, Stegmayr BG, Dahlqvist SR: Renal abnormalities in a population of patients with psoriatic arthritis. Scand J Rheumatol 2001, 30: 271–274.

    Article  PubMed  CAS  Google Scholar 

  19. Brockbank JE, Stein M, Schentag CT, Gladman DD: Dactylitis in psoriatic arthritis: a marker for disease severity? Ann Rheum Dis 2005, 64: 188–190.

    Article  PubMed  CAS  Google Scholar 

  20. Olivieri I, Barozzi L, Favaro L, et al.: Dactylitis in patients with seronegative spondylarthropathy. Assessment by ultrasonography and magnetic resonance imaging. Arthritis Rheum 1996, 39: 1524–1528.

    CAS  Google Scholar 

  21. Olivieri I, Salvarani C, Cantini F, et al.: Fast spin echo-T2-weighted sequences with fat saturation in dactylitis of spondylarthritis. No evidence of entheseal involvement of the flexor digitorum tendons. Arthritis Rheum 2002, 46: 2964–2967.

    Google Scholar 

  22. Olivieri I, Scarano E, Padula A, Giasi V: Dactylitis involving most of the fingers. Clin Exp Rheumatol 2003, 21: 406.

    PubMed  CAS  Google Scholar 

  23. McGonagle D: Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis. Ann Rheum Dis 2005, 64(Suppl 2): ii58–60.

    Article  PubMed  Google Scholar 

  24. Cantini F, Salvarani C, Olivieri I, et al.: Distal extremity swelling with pitting edema in psoriatic arthritis: a casecontrol study. Clin Exp Rheumatol 2001, 19: 291–296.

    PubMed  CAS  Google Scholar 

  25. Healy PJ, Groves C, Chandramohan M, Helliwell PS: MRI changes in psoriatic dactylitis—extent of pathology, relationship to tenderness and correlation with clinical indices. Rheumatology 2008, 47: 92–95.

    Article  PubMed  CAS  Google Scholar 

  26. Jevtic V, Watt I, Rozman B, et al.: Distinctive radiological features of small hand joints in rheumatoid arthritis and seronegative spondyloarthritis demonstrated by contrastenhanced (Gd-DTPA) magnetic resonance imaging. Skeletal Radiol 1995, 24: 351–355.

    Article  PubMed  CAS  Google Scholar 

  27. McGonagle D, Gibbon W, O’Connor P, et al.: Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 1998, 41: 694–700. (Comment in: Arthritis Rheum 2000, 43: 712–714.)

    Article  PubMed  CAS  Google Scholar 

  28. Bollow M, Fischer T, Reisshauer H, et al.: Quantitative analyses of sacroiliac biopsies in spondyloarthropathies: T cells and macrophages predominate in early and active sacroiliitis—cellularity correlates with the degree of enhancement detected by magnetic resonance imaging. Ann Rheum Dis 2000, 59: 135–140.

    Article  PubMed  CAS  Google Scholar 

  29. Williamson L, Dockerty JL, Dalbeth N, et al.: Clinical assessment of sacroiliitis and HLA-B27 are poor predictors of sacroiliitis diagnosed by magnetic resonance imaging in psoriatic arthritis. Rheumatology 2004, 43: 85–88.

    Article  PubMed  CAS  Google Scholar 

  30. McGonagle D, Marzo-Ortega H, O’Connor P, et al.: The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy. Arthritis Rheum 2002, 46: 489–493.

    Article  PubMed  Google Scholar 

  31. McGonagle D, Marzo-Ortega H, O’Connor P, et al.: Histological assessment of the early enthesitis lesion in spondyloarthropathy. Ann Rheum Dis 2002, 61: 534–537.

    Article  PubMed  CAS  Google Scholar 

  32. Althoff CE, Appel H, Rudwaleit M, et al.: Whole-body MRI as a new screening tool for detecting axial and peripheral manifestations of spondyloarthritis. Ann Rheum Dis 2007, 66: 983–985.

    Article  PubMed  CAS  Google Scholar 

  33. McGonagle D, Pease C, Marzo-Ortega H, et al.: Comparison of extracapsular changes by magnetic resonance imaging in patients with rheumatoid arthritis and polymyalgia rheumatica. J Rheumatol 2001, 28: 1837–1841.

    PubMed  CAS  Google Scholar 

  34. Zhu F, Johnson JE, Hirose CB, Bae KT: Chronic plantar fasciitis: acute changes in the heel after extracorporeal high-energy shock wave therapy—observations at MR imaging. Radiology 2005, 234: 206–210.

    Article  PubMed  Google Scholar 

  35. Giovagnoni A, Grassi W, Terilli F, et al.: MRI of the hand in psoriatic and rheumatical arthritis. Eur Radiol 1995, 5: 590–595.

    Article  Google Scholar 

  36. McQueen FM: A vital clue to deciphering bone pathology: MRI bone oedema in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 2007, 66: 1549–1552.

    Article  PubMed  CAS  Google Scholar 

  37. Jimenez-Boj E, Nöbauer-Huhmann I, Hanslik-Schnabel F, et al.: Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 2007, 56: 1118–1124.

    Article  PubMed  Google Scholar 

  38. McQueen FM, Gao A, Østergaard M, et al.: High grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone. Ann Rheum Dis 2007, 66: 1581–1587.

    Article  PubMed  CAS  Google Scholar 

  39. Rudwaleit M, Baraliakos X, Listing J, et al.: Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept. Ann Rheum Dis 2005, 64: 1305–1310. (Published erratum appears in Ann Rheum Dis 2005, 64: 1668.)

    Article  PubMed  CAS  Google Scholar 

  40. Anandarajah AP, Schwarz EM, Totterman S, et al.: The effect of etanercept on osteoclast precursor frequency and enhancing bone marrow oedema in patients with psoriatic arthritis. Ann Rheum Dis 2008, 67: 296–301.

    Article  PubMed  CAS  Google Scholar 

  41. Bongartz T, Harle P, Friedrich S, et al.: Successful treatment of psoriatic onycho-pachydermo periostitis (POPP) with adalimumab. Arthritis Rheum 2005, 52: 280–282.

    Article  PubMed  CAS  Google Scholar 

  42. Kane D, Stafford L, Bresnihan B, FitzGerald O: A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology 2003, 42: 1460–1468.

    Article  PubMed  CAS  Google Scholar 

  43. Ritchlin CT, Haas-Smith SA, Li P, et al.: Mechanisms of TNF-alpha-and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest 2003, 111: 821–831.

    PubMed  CAS  Google Scholar 

  44. Lee J, Dalbeth N, Smith T, et al.: Osteoclast precursor numbers from peripheral blood following cytokine stimulation are increased in psoriatic arthritis patients with arthritis mutilans defined radiographically. Arthritis Rheum 2007, 56: S483.

    Google Scholar 

  45. Wassenberg S, Fischer-Kahle V, Herborn G, Rau R: A method to score radiographic change in psoriatic arthritis. Z Rheumatol 2001, 60: 156–166.

    Article  PubMed  CAS  Google Scholar 

  46. Diarra D, Stolina M, Polzer K, et al.: Dickkopf-1 is a master regulator of joint remodeling. Nat Med 2007, 13: 156–163. (Comment in: Nat Med 2007, 13: 133–134.)

    Article  PubMed  CAS  Google Scholar 

  47. Heuft-Dorenbosch L, Landewe R, Weijers R, et al.: Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 2006, 65: 804–808.

    Article  PubMed  CAS  Google Scholar 

  48. Brandt J, Bollow M, Haberle J, et al.: Studying patients with inflammatory back pain and arthritis of the lower limbs clinically and by magnetic resonance imaging: many, but not all patients with sacroiliitis have spondyloarthropathy. Rheumatology 1999, 38: 831–836.

    Article  PubMed  CAS  Google Scholar 

  49. Queiro R, Belzunegui J, Gonzalez C, et al.: Clinically asymptomatic axial disease in psoriatic spondyloarthropathy. A retrospective study. Clin Rheumatol 2002, 21: 10–13.

    Article  PubMed  CAS  Google Scholar 

  50. Resnick D: Radiology of seronegative spondyloarthropathies. Clin Orthop Relat Res 1979, (143): 38–45.

    PubMed  Google Scholar 

  51. Tuzun C, Peker O, Kucuktas F, et al.: An atypical psoriatic spondylitis case, successfully treated with methotrexate. Clin Rheumatol 1996, 15: 403–409.

    Article  PubMed  CAS  Google Scholar 

  52. Fournie B, Viraben R, Durroux R, et al.: Psoriatic onycho-pachydermo-periostitis of the big toe. Anatomo-clinical study and physiopathogenic approach apropos of 4 cases [in French]. Rev Rhum Mal Osteoartic 1989, 56: 579–582.

    PubMed  CAS  Google Scholar 

  53. Tan AL, Benjamin M, Toumi H, et al.: The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis—a high-resolution MRI and histological study. Rheumatology (Oxford) 2007, 46: 253–256.

    Article  CAS  Google Scholar 

  54. Offidani A, Cellini A, Valeri G, Giovagnoni A: Subclinical joint involvement in psoriasis: magnetic resonance imaging and X-ray findings. Acta Derm Venereol 1998, 78: 463–465. (Comment in: Acta Derm Venereol 1999, 79: 407.)

    Article  PubMed  CAS  Google Scholar 

  55. Namey TC, Rosenthall L: Periarticular uptake of 99mtechnetium diphosphonate in psoriatics: correlation with cutaneous activity. Arthritis Rheum 1976, 19: 607–612.

    Article  PubMed  CAS  Google Scholar 

  56. Brown AK, Quinn MA, Karim Z, et al.: Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 2006, 54: 3761–3773.

    Article  PubMed  CAS  Google Scholar 

  57. Østergaard M, Peterfy C, Conaghan P, et al.: OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 2003, 30: 1385–1386.

    PubMed  Google Scholar 

  58. McQueen F, Lassere M, Bird P, et al.: Developing a magnetic resonance imaging scoring system for peripheral psoriatic arthritis. J Rheumatol 2007, 34: 859–861.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Molecular Medicine and Pathology, University of Auckland, Private Bag 92019, Auckland, New Zealand

    Fiona M. McQueen

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  1. Fiona M. McQueen
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  2. Nicola Dalbeth
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  3. Anthony Doyle
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Correspondence to Fiona M. McQueen.

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McQueen, F.M., Dalbeth, N. & Doyle, A. MRI in psoriatic arthritis: Insights into pathogenesis and treatment response. Curr Rheumatol Rep 10, 303–310 (2008). https://doi.org/10.1007/s11926-008-0049-y

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