Abstract
Objective In 2015, the European Alliance of Associations for Rheumatology (EULAR) published recommendations for the use of imaging for the diagnosis and management of spondyloarthritis in clinical practice. These recommendations included the use of ultrasound in patients with psoriatic arthritis (PsA), but the management was not clearly distinguished from spondyloarthritis. We aimed to systematically review the literature on the role of ultrasound for the management of PsA, and to propose pragmatic algorithms for its use in clinical practice.
Methods A group of ten rheumatologists, experienced in imaging and musculoskeletal ultrasound, met with the objectives of formulating key questions for systematic literature review (SLR), appraising the available evidence and then proposing algorithms on the application of ultrasound in suspected or established PsA, based on both literature and experts' opinion following a Delphi process.
Results The SLR included 120 articles, most of which focused on the diagnostic process. The elevated number of articles retrieved suggest the interest of rheumatologist to use ultrasound in the PsA management. After a consensual discussion on literature data and expert opinion, three algorithms were developed to be used in practical situations: suspicion of PsA, management of PsA either with good or insufficient clinical response.
Conclusion The SLR showed the interests in using ultrasound to objectively evaluate PsA for diagnosis and management. We proposed three practical algorithms to guide its use in the clinical management of patients, from the diagnosis to the assessment of treatment response. Further studies are needed to define remission and to assess ultrasound ability to predict disease severity.
