MR imaging features of foot involvement in patients with psoriasis

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Abstract

Objective

To determine alterations of the soft tissues, tendons, cartilage, joint spaces, and bones of the foot using magnetic resonance (MR) imaging in patients with psoriasis.

Materials and methods

Clinical and MR examination of the foot was performed in 26 consecutive patients (52 ft) with psoriasis. As a control group, 10 healthy volunteers (20 ft) were also studied. Joint effusion/synovitis, retrocalcaneal bursitis, retroachilles bursitis, Achilles tendonitis, soft-tissue edema, para-articular enthesophytes, bone marrow edema, sinus tarsi syndrome, enthesopathy at the Achilles attachment and at the plantar fascia attachment, plantar fasciitis, tenosynovitis, subchondral cysts, and bone erosions, joint space narrowing, subchondral signal changes, osteolysis, luxation, and sub-luxation were examined.

Results

Clinical signs and symptoms (pain and swelling) due to foot involvement were present in none of the patients while frequency of involvement was 92% (24/26) by MR imaging. The most common MR imaging findings were Achilles tendonitis (acute and peritendinitis) (57%), retrocalcaneal bursitis (50%), joint effusion/synovitis (46%), soft-tissue edema (46%), and para-articular enthesophytes (38%). The most commonly involved anatomical region was the hindfoot (73%).

Conclusion

Our data showed that the incidence of foot involvement was very high in asymptomatic patients with psoriasis on MR imaging. Further MR studies are needed to confirm these data. We conclude that MR imaging may be of importance especially in early diagnosis and treatment of inflammatory changes in the foot.

Introduction

Psoriasis is a common, chronic, persistent, inflammatory skin disorder that can have major effect on quality of life. The relationship between psoriasis and inflammatory arthritis has been well recognized since the 19th century and named as psoriatic arthritis (PsA) [1]. Foot involvement in PsA is common and often develops early in the disease [2]. Detailed imaging of foot and ankle can be problematic, because of the complex three-dimensional anatomy. Magnetic resonance (MR) imaging allows direct, noninvasive depiction of tendon, bone and soft-tissue structures of the foot and ankle by its superior soft-tissue contrast resolution and multiplanar capability [3]. The features of foot involvement in PsA using conventional radiography have been reported [4]. To the best of our knowledge, foot involvement assessed by MR imaging in patients with psoriasis has not been reported. The aim of this prospective study was to determine the features of foot involvement using MR imaging in patients with psoriasis.

Section snippets

Materials and methods

This study was a prospective trial with a standardized protocol. Twenty-six consecutive psoriasis patients (14 female, 12 male; aged 19–64 years; mean 44.2 ± 13.6) were enrolled. They had no arthritic signs or symptoms either in the foot or other joints and were all negative for serum rheumatoid factor. The mean duration of the disease in the study population was 1–37 years with a mean of 23 ± 9.5 years. As a control group; 10 (6 female, 4 male; aged 20–63 years; mean 42.9 ± .12.9) asymptomatic

Results

In the control cases no abnormalities were found. However, changes were found in 24 (92%) of 26 psoriasis patients. In 3 out of 26 patients, the duration of disease was 1 year and all of them showed changes on MR. In the 24 patients with abnormalities in MR, asymmetric, bilateral changes were seen in 16 (67%), and bilateral symmetric changes were noted in 8 (33%). The remaining two patients with psoriasis had no imaging findings. The imaging findings in patients with psoriasis are summarized in

Discussion

Foot and ankle are commonly involved by inflammatory joint disease [11]. Clinical and radiological changes in the foot should be evaluated with care, as they provide valuable diagnostic and prognostic information to guide treatment in patients with inflammatory arthritis [1], [11]. It has been well recognized that MR imaging is more sensitive than clinical examination in the detection of inflammatory changes such as synovitis, tenosynovitis, and enthesopathy and also bone erosions earlier than

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