4MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis
Section snippets
Magnetic resonance imaging
The potential for imaging studies to contribute to the understanding of the pathogenesis of PsA is well recognised [2]. However, there has been very little work done using modern imaging such as MRI and ultrasound in PsA, especially in early disease, to improve our insight into the disease. High-field MRI with contrast enhancement is arguably the ‘gold standard’ for simultaneously imaging soft tissue and bony pathology in PsA. MRI is the most sensitive imaging modality for the assessment of
Current role of MRI: pathology
MRI allows visualisation of the diverse pathological tissues in PsA. These differing features can be used to aid diagnosis of PsA.
Synovitis and bone abnormalities
Technically, peripheral joint assessment using US in PsA is identical to that for RA, employing GS and PD modalities. There are, however, differences in pathology identified by US. Fournie's group showed that while the synovial membrane of joints and tendon sheaths could be involved in both conditions, extra-synovial abnormalities were only seen in PsA patients. These included abnormalities denoting enthesitis, thickening of soft tissues and Doppler signal from the base of the nail indicating
Summary
The use of MRI and US in PsA is becoming much more commonplace in both clinical and research fields. Both imaging techniques are being used in early diagnosis and identification of disease, including identifying pre-clinical changes in patients who only have skin psoriasis. They are also increasingly becoming accepted in monitoring disease outcome and identifying responses to treatment. OMERACT groups are leading the development of validated scoring systems that can be used as outcome measures
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2021, Dermatologic ClinicsCitation Excerpt :There also are ultrasonographic criteria for diagnosing bilateral retronychia.34 The use of ultrasound and MRI has increased in psoriasis, and there are ultrasonographic patterns of involvement of the nail bed and nail plate as well as a scoring system for evaluating psoriatic arthropathy on MRI called the PsA MRI Score.10,35–51 On ultrasound, psoriatic onychopathy shows thickening of the nail bed, loss of definition of the ventral plate; hyperechoic deposits in the distal part of the ventral plate; and the presence of thick, irregular, and wavy nail plates.1,8
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