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. 2005 Mar;64(Suppl 2):ii58–ii60. doi: 10.1136/ard.2004.034264

Imaging the joint and enthesis: insights into pathogenesis of psoriatic arthritis

D McGonagle
PMCID: PMC1766889  PMID: 15708939

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Figure 1.

Figure 1

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 Magnetic resonance imaging (MRI) of the sacroiliac joint (A) and sternoclavicular joint (B) in patients with PsA. The bone adjacent to these fibrocartilaginous joints is subject to both shear and compressive forces with the MRI changes in the bone at these sites being virtually identical to that seen in bone adjacent to the fibrocartilages of large entheses such as Achilles' tendon and plantar fascia. (A) Coronal fat suppressed MRI scan of the sacroiliac joint of a male with psoriasis, peripheral arthritis, inflammatory back pain and negative human leucocyte antigen (HLA)-B27. Osteitis is denoted by asterisks. (B) Fat suppressed coronal MRI scan of the sternoclavicular joint in a male patient with psoriatic arthritis and the SAPHO syndrome. Bone oedema is adjacent to the joint fibrocartilage (asterisk) and joint swelling (arrow). These are examples of sites with high shear and compressive stress. It is suggested that these synovial joints behave like functional entheses in having a similar MRI pattern of disease as a typical insertion and hence the extensive bone disease that is independent of synovitis. (Images courtesy of Dr L Sutton, Calderdale Royal Hospital, Halifax, UK.)

Figure 2.

Figure 2

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 Fat suppressed MRI of the metacarpophalangeal (MCP) joint in a patient with psoriatic arthritis shows extracapsular inflammation (asterisk), bone oedema at the distal capsular enthesis (arrow), and bone oedema in the MCP head region where bone oedema and erosions may also occur in rheumatoid arthritis (arrowhead).

Figure 3.

Figure 3

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 Radiograph of the feet of a patient with symmetrical polyarthritis with ulnar deviation of the hands and fibular deviation of the feet. The radiograph reveals joint fusion at multiple sites (arrows on top) and the fifth left metatarsal phalangeal head and adjacent proximal phalanx demonstrate pencil in cup deformity (arrow on left), features which help distinguish this as psoriatic arthritis rather than rheumatoid arthritis (RA). This case illustrates how imaging has the potential to clarify that the diagnosis is what clinically masquerades as RA.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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