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Research ArticleArticle

Enthesitis and Related Changes in the Knees in Seronegative Spondyloarthropathies and Skin Psoriasis: Magnetic Resonance Imaging Case-Control Study

YASSER EMAD, YASSER RAGAB, IMAN BASSYOUNI, OMAR MOAWAYH, MAGDY FAWZY, AHMED SAAD, ALAA ABOU-ZEID and JOHANNES J. RASKER
The Journal of Rheumatology August 2010, 37 (8) 1709-1717; DOI: https://doi.org/10.3899/jrheum.100068
YASSER EMAD
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  • For correspondence: yasseremad68@yahoo.com
YASSER RAGAB
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IMAN BASSYOUNI
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OMAR MOAWAYH
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MAGDY FAWZY
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AHMED SAAD
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ALAA ABOU-ZEID
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JOHANNES J. RASKER
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  • Figure 1.
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    Figure 1.

    Psoriatic arthritis: A (sagittal) and B (coronal) STIR sequence images show enhancement close to the tibial insertion of posterior cruciate ligament (PCL), with periligamentous high signal intensity compatible with fluid, moderate knee effusion, and focal bone marrow edema at the tibial insertion of the PCL (black arrow). C (sagittal) and D (axial) postcontrast T1 fat saturated images show enhancement at entheseal sites close to PCL and MCL and femoral insertions of biceps femoris tendon.

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    Figure 2.

    Ankylosing spondylitis: A. Right knee PD fat saturated image shows enthesitis at the patellar tendon insertion (white arrow). Ulcerative colitis: B. Axial PD fat saturated image shows enthesitis at the medial patellar retinaculum (white arrow). Crohn’s disease: C (coronal) and D (axial) PD fat saturated images show enthesitis at the lateral collateral ligament of the right knee in the same patient (white arrows).

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    Figure 3.

    Skin psoriasis: A. Right knee coronal PD fat saturated image shows bone marrow edema (white arrow). B. Sagittal PD fat saturated image shows soft tissue edema and enthesitis at the patellar tendon insertion (white arrow) in another patient with skin psoriasis. C. Right knee coronal PD fat saturated image shows enthesitis at the medial patellofemoral ligament (white arrow). D. Right knee sagittal PD fat saturated image shows coexisting enthesitis in the same knee at the patellar tendon.

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    Table 1.

    Clinical and demographic characteristics of the studied groups of patients. Data are the mean ± SD unless otherwise indicated.

    CharacteristicPsA, n = 30AS, n = 5ReA, n = 5UC, n = 5Crohn’s Disease, n = 5Skin Psoriasis, n = 6
    Sex, no. (%)
    Male18 (60)4 (80)4 (80)2 (40)3 (60)1 (16.7)
    Female12 (40)1 (20)1 (20)3 (60)2 (40)5 (83.3)
    Age*38.3 ± 8.235.2 ± 5.233.4 ± 4.237.8 ± 7.938.6 ± 5.439 ± 7.9
    Age at onset*35.8 ± 8.230.4 ± 3.331.2 ± 3.336.4 ± 7.835.8 ± 6.635.2 ± 7.7
    Disease duration*30.3 ± 20.157.6 ± 39.315 ± 5.216.8 ± 10.731.2 ± 16.142 ± 18.2
    Manifestations, no. (%)
      SJC, no. (%)3.8 ± 1.241 ± 1.43.6 ± 2.10.0 ± 0.01 ± 1.40.0 ± 0.0
      TJC3.6 ± 1.51 ± 1.43.6 ± 2.10.0 ± 0.01 ± 1.40.0 ± 0.0
      Sacroiliitis27 (90)5 (100)2 (40)2 (40)0 (0)0 (0)
      Clinical tenosynovitis12 (40)0 (0)1 (20)0 (0)1 (20)0 (0)
      Nail dystrophy28 (93.3)0 (0)0 (0)0 (0)0 (0)6 (100)
      Spinal disease28 (93.3)5 (100)0 (0)0 (0)0 (0)0 (0)
      Slit lamp changes28 (93.3)4 (80)0 (0)0 (0)0 (0)0 (0)
    Treatment, no. (%)
      Methotrexate30 (100)5 (100)5 (100)0 (0)0 (0)0 (0)
      Anti-TNF0 (0)5 (100)0 (0)0 (0)0 (0)0 (0)
      Steroids0 (0)0 (0)0 (0)5 (100)5 (100)0 (0)
      Sulfasalazine2 (6.7)0 (0)1 (20)0 (0)0 (0)0 (0)
      Mesalamine0 (0)0 (0)0 (0)5 (100)5 (100)0 (0)
      Azathioprine0 (0)0 (0)0 (0)5 (100)5 (100)0 (0)
      Topical treatment30 (100)0 (0)0 (0)0 (0)0 (0)6 (100)
    • SJC: Swollen joint count; TJC: tender joint count; PsA: psoriatic arthritis; AS: ankylosing spondylitis; ReA: reactive arthritis; UC: ulcerative colitis.

    • ↵* Mean ± SD.

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    Table 2.

    Laboratory investigations and detailed MRI findings among the studied groups of patients. Data are the mean ± SD unless otherwise indicated.

    CharacteristicPsA, n = 30AS, n = 5ReA, n = 5UC, n = 5Crohn’s Disease, n = 5Skin Psoriasis, n = 6
    ESR, mm/h*42.6 ± 9.8146.6 ± 4.8356.6 ± 13.0319.2 ± 8.1721.8 ± 8.3213.5 ± 3.56
    CRP, mg/dl*3.23 ± 1.253.6 ± 0.824.34 ± 3.02.6 ± 1.031.7 ± 1.30.6 ± 0.49
    Side of MRI, no. (%)
      Unilateral9 (30)0 (0)2 (40)0 (0)0 (0)0 (0)
      Bilateral21 (70)5 (100)3 (60)5 (100)5 (100)6 (100)
    Synovial thickness, mm*2.66 ± 0.942.24 ± 1.22.66 ± 0.970.92 ± 0.311.3 ± 0.4141.8 ± 0.82
    Manifestations, no. (%)
      Soft tissue edema21 (70)1 (20)2 (40)1 (20)1 (20)2 (33.3)
      Bone erosions7 (23.3)1 (20)2 (40)0 (0)0 (0)0 (0)
      Cartilage erosions12 (40)1 (20)3 (60)2 (40)0 (0)0 (0)
      Baker’s cyst3 (10)0 (0)1 (20)0 (0)0 (0)0 (0)
      BME8 (26.7)2 (40)2 (40)0 (0)0 (0)1 (16.7)
        Single lesion in the same joint28 (93.3)4 (80)4 (80)2 (40)3 (60)4 (66.7)
        Combined lesions in the same joint2 (6.7)1 (20)1 (20)0 (0)0 (0)1 (16.7)
    Enthesitis by site, no. (%)
      MCL12 (40)2 (40)2 (40)1 (20)1 (20)0 (0)
      LCL5 (16.7)2 (40)0 (0)0 (0)1 (20)0 (0)
      ACL0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)
      PCL2 (6.7)0 (0)1 (20)0 (0)0 (0)0 (0)
      Patellar tendon insertion7 (23.3)1 (20)3 (60)1 (20)0 (0)5 (83.3)
      Biceps femoris insertion3 (10)0 (0)0 (0)0 (0)0 (0)0 (0)
      MPFL2 (6.7)1 (20)0 (0)0 (0)1 (20)1 (16.7)
      LPFL1 (3.3)0 (0)0 (0)0 (0)0 (0)0 (0)
    • ↵* Mean ± SD. PsA: psoriatic arthritis; AS: ankylosing spondylitis; ReA: reactive arthritis; UC: ulcerative colitis; BME: bone marrow edema; MCL: medial collateral ligament; LCL: lateral collateral ligament; ACL: anterior cruciate ligament; PCL: posterior cruciate, MPFL: medial patellofemoral ligament; LPFL: lateral patellofemoral ligament.

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The Journal of Rheumatology
Vol. 37, Issue 8
1 Aug 2010
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Enthesitis and Related Changes in the Knees in Seronegative Spondyloarthropathies and Skin Psoriasis: Magnetic Resonance Imaging Case-Control Study
YASSER EMAD, YASSER RAGAB, IMAN BASSYOUNI, OMAR MOAWAYH, MAGDY FAWZY, AHMED SAAD, ALAA ABOU-ZEID, JOHANNES J. RASKER
The Journal of Rheumatology Aug 2010, 37 (8) 1709-1717; DOI: 10.3899/jrheum.100068

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Enthesitis and Related Changes in the Knees in Seronegative Spondyloarthropathies and Skin Psoriasis: Magnetic Resonance Imaging Case-Control Study
YASSER EMAD, YASSER RAGAB, IMAN BASSYOUNI, OMAR MOAWAYH, MAGDY FAWZY, AHMED SAAD, ALAA ABOU-ZEID, JOHANNES J. RASKER
The Journal of Rheumatology Aug 2010, 37 (8) 1709-1717; DOI: 10.3899/jrheum.100068
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