Table 1.
Revised articles about US.
| Ultrasonography and diagnosis in PsA | |||
|---|---|---|---|
| First Author | Reference | Title | Description |
| Zabotti et al. (26) | RMD Open. (2019) | Transition phase toward psoriatic arthritis: clinical and ultrasonographic characterization of psoriatic arthralgia. | Tenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. |
| Idolazzi et al. (38) | Clin Rheumatol. (2019) | The ultrasonographic study of the nail reveals differences in patients affected by inflammatory and degenerative conditions. | Ultrasonography nails in psoriasis/PsA/osteoarthritis |
| Tinazzi et al. (39) | Med Ultrason. (2019) | Ultrasonographic detection, definition and quantification of soft tissue oedema in psoriatic dactylitis. | Soft tissue edema in psoriatic dactylitis |
| Tang et al. (40) | Quant Imaging Med Surg. (2020) | Ultrasound assessment in psoriatic arthritis (PsA) and psoriasis vulgaris (non-PsA): which sites are most commonly involved and what features are more important in PsA? | Affected sites compared between PsA and PsO patients |
| Helliwell et al. (41) | J Rheumatol. (2019) | Comparing psoriatic arthritis low-field magnetic resonance imaging, ultrasound, and clinical outcomes: data from the TICOPA trial. | Comparison MRI and US |
| Florescu et al. (24) | Curr Health Sci J. (2019) | The Role of Ultrasound in Assessing Hand Joints and Tendons in Psoriatic Arthritis. | Most affected sites: 3rd finger, flexor tendons, extensor carpi ulnaris, flexor carpi radialis |
| Furlan et al. (29) | J Ultrasound. (2018) | The thickening of flexor tendons pulleys: a useful ultrasonographical sign in the diagnosis of psoriatic arthritis. | Good sensitivity, poor specificity |
| Krajewska-Włodarczyk et al. (42) | Biomed Res Int. (2018) | Ultrasound assessment of changes in nails in psoriasis and psoriatic arthritis. | The findings of this study may indicate an association of an inflammation in the nail bed with PsA development. Apart from a direct assessment of the described morphological changes of nails, a US examination could prove useful in an assessment of intensity of a local inflammation as a prognostic factor for PsA development. |
| Mondal et al. (43) | Rheumatol Int. (2018) | Assessment of nail unit structures by ultrasound in patients with psoriatic arthritis and their correlations with disease activity indices: a case-control study. | Ultrasound (USG) of nail was performed to assess, (1) morphological alterations of nail plates in psoriatic arthritis (PsA) patients, (2) differences of nail unit parameters [nail bed thickness (NBT), nail matrix thickness (NMT) and nail plate distance (NPD)] in PsA patients from healthy controls (3) correlation of nail unit parameters with PsA disease activity indices. Total of 895 fingernails (448 nails of 45 PsA patients and 447 of 45 controls) were evaluated by USG. Psoriasis Area and Severity Index (PASI), Disease Activity in Psoriatic Arthritis (DAPSA), and Nail Psoriasis Severity Index (NAPSI) were calculated in PsA patients. Nail unit parameters were compared between two study groups. Correlation study was done between nail unit parameters and disease activity indices. All PsA patients showed ultrasound evidence of nail plate changes (87.95% of the total fingernails and 75.34% of the clinically normal nails). Loosening of the ventral nail plate border was most common (51.79%). Mean NBT (PsA: 0.19 ± 0.035 cm, control: 0.17 ± 0.018 cm, p = 0.003) and mean NMT (PsA: 0.32 ± 0.041 cm, control: 0.28 ± 0.031 cm, p ≤ 0.0001) were significantly increased in the PsA patients. Moderately positive correlation was observed between NAPSI score and mean NMT (Spearman r = 0.411, 95% confidence interval: 0.125–0.634, p = 0.005). USG evidence of nail plate alterations was frequent among PsA patients, even in clinically normal nails. Increased mean nail bed and matrix thickness were noted in PsA patients. Mean NMT had a moderately positive correlation with NAPSI score. |
| Macía-Villa et al. (44) | Clin Exp Rheumatol. (2018) | What is metacarpophalangeal joint swelling in psoriatic arthritis? Ultrasound findings and reliability assessment. | Clinical swelling was present in 60 joints whereas US detected IAS and/or PTI in 75 MCPj. GS PTI in at least one MCPj was found in 19 patients and 41 joints, concurring with clinical swelling in 30/41. GS IAS in at least one MCPj was found in 23 patients and 63 joints, concurring with clinical swelling in 37/63. The inter-reader reliability was good for PD PTI and moderate for GS PTI. |
| Højgaard et al. (45) | Arthritis Care Res (Hoboken). (2019) | Pain mechanisms and ultrasonic inflammatory activity as prognostic factors in patients with psoriatic arthritis: a prospective cohort study. | More than one-third of patients with PsA presented with WP, which was associated with worse patient-reported scores and failure to achieve minimal disease activity following conventional synthetic or biologic disease-modifying antirheumatic drug therapy. PsA activity by color Doppler US had no influence on subsequent treatment response in this PsA cohort. |
| Idolazzi et al. (46) | Med Ultrason. (2018) | Ultrasonography of the nail unit reveals quantitative and qualitative alterations in patients with psoriasis and psoriatic arthritis. | Multivariate analysis of variance was performed between groups. Post-hoc analysis underlined the differences between healthy and affected regarding nail plate thickness (0.063 ± 0.011 cm for patients with psoriasis, 0.065 ± 0.014 cm for patients with psoriatic arthritis and 0.051 ± 0.006 cm for healthy controls, p < 0.05). Elementary lesions of nail plate and nail bed were compared using Pearson's chi square test between patients in psoriasis and psoriatic arthritis groups, with no differences except for a trend for onycholisis and crumbling (p = 0.07 and 0.06, respectively) in the psoriatic arthritis group. ROC curves were calculated (AUC = 0.68) obtaining also quantitative cut offs for nail plate and nail bed thickness in the affected vs. healthy patients. |
| Zabotti et al. (25) | Ann Rheum Dis. (2018) | Ultrasonography in psoriatic arthritis: which sites should we scan? | In psoriatic arthritis (PsA), ultrasonography (US) plays a growing role in the differential diagnosis and in monitoring treatment response (1), PsA is a heterogeneous disease with different domains and peculiar sites involved (2). Therefore, a dedicated US composite score is needed to monitor disease activity and to identify structural damage progression. A recently published Systematic Literature Review (SLR) identified only two US scores specifically developed for PsA (i.e., 5TPD and PsA-Son) and, although these had a good sensitivity to detect inflammation and a good feasibility, they have not been validated in other series (1, 3, 4). Recently, the Study Group for US of the Italian Society of Rheumatology promoted the Ultrasound in PSoriatic Arthritis TREAtMent (UPSTREAM) study (registered at ClinicalTrial.gov, NCT03330769). UPSTREAM is a multicenter observational prospective cohort study and it represents the first |
| Tinazzi et al. (30) | Ann Rheum Dis. (2018) | “Deep Koebner” phenomenon of the flexor tendon-associated accessory pulleys as a novel factor in tenosynovitis and dactylitis in psoriatic arthritis. | In established PsA, the accessory pulleys are thickened compared with RA, PsO, or HCs and especially in subjects with a history of dactylitis. These findings implicate the involvement of pulleys in PsA-related tenosynovitis and dactylitis supporting the idea of deep koebnerization in dactylitis and sites of high physical stress. |
| Zabotti et al. (25) | J Rheumatol. (2018) | Early psoriatic arthritis vs. early seronegative rheumatoid arthritis: role of dermoscopy combined with ultrasonography for differential diagnosis. | Integrated rheumatological-dermatological clinical evaluation may be helpful in identifying patients with EPsA misclassified as seronegative ERA. Additionally, US and dermoscopy may be used as supportive tools in identifying subclinical psoriatic features, which may come in handy in distinguishing EPsA from ERA. |
| Ahmed et al. (47) | Open Access Maced J Med Sci. (2017) | Ultrasonographic enthesopathy and disease activity in psoriatic arthritis. | Of 70 entheses in 35 active PsA patients, the most entheseal abnormalities were tender plantar fascia (18.5%), tender Achilles tendon (37.8%). PASDAS was a direct highly significant correlated with plantar fascia and Achilles tendon thickness in in active PsA (r = 0.823 and 0.796, p < 0.001, respectively). Musculoskeletal US is an accurate and low-cost method for assessment of enthesopathy with significant correlation to disease activities in psoriatic arthritis. |
| Aydin et al. (32) | Clin Exp Rheumatol. (2017) | Vascularity of nail bed by ultrasound to discriminate psoriasis, psoriatic arthritis and healthy controls. | |
| Uson et al. (48) | Reumatol Clin. (2018) | Recommendations for the use of ultrasound and magnetic resonance in patients with spondyloarthritis, including psoriatic arthritis, and patients with juvenile idiopathic arthritis. | |
| Fiocco et al. (49) | Clin Rheumatol. (2017) | Quantitative imaging by pixel-based contrast-enhanced ultrasound reveals a linear relationship between synovial vascular perfusion and the recruitment of pathogenic IL-17A-F+IL-23+ CD161+ CD4+ T helper cells in psoriatic arthritis joints. | To develop quantitative imaging biomarkers of synovial tissue perfusion by pixel-based contrast-enhanced ultrasound (CEUS), we studied the relationship between CEUS synovial vascular perfusion and the frequencies of pathogenic T helper (Th)-17 cells in psoriatic arthritis (PsA) joints. Eight consecutive patients with PsA were enrolled in this study. Gray scale CEUS evaluation was performed on the same joint immediately after joint aspiration, by automatic assessment perfusion data, using a new quantification approach of pixel-based analysis and the gamma-variate model. The set of perfusional parameters considered by the time intensity curve includes the maximum value (peak) of the signal intensity curve, the blood volume index or area under the curve, (BVI, AUC) and the contrast mean transit time (MTT). The direct ex vivo analysis of the frequencies of SF IL17A-F+CD161+IL23+ CD4+ T cells subsets were quantified by fluorescence-activated cell sorter (FACS). In cross-sectional analyses, when tested for multiple comparison setting, a false discovery rate at 10%, a common pattern of correlations between CEUS Peak, AUC (BVI), and MTT parameters with the IL17A-F+IL23+–IL17A-F+CD161+–and IL17A-F+CD161+IL23+ CD4+ T cells subsets, as well as lack of correlation between both peak and AUC values and both CD4+T and CD4+IL23+ T cells, was observed. The pixel-based CEUS assessment is a truly measure synovial inflammation, as a useful tool to develop quantitative imaging biomarker for monitoring target therapeutics in PsA. |
| Ultrasonography and monitoring in PsA | |||
| Ceccarelli et al. (50) | Clin Rheumatol. (2019) | Musculoskeletal ultrasound in monitoring response to apremilast in psoriatic arthritis patients: results from a longitudinal study. | MSUS can monitor articular and periarticular response to apremilast in PsA |
| Bosch et al. (35) | Rheumatology (Oxford). (2019) | Evaluating current definitions of low disease activity in psoriatic arthritis using ultrasound. | The LDA cut-offs of DAPSA, PASDAS, Composite Psoriatic Disease Activity Index, minimal disease activity, but not DAS28-CRP are capable of distinguishing between high and low ultrasound activity. Pain and pain-related items are the main reason why PsA patients without signs of ultrasound inflammation are classified with higher disease activity. |
| Pukšić et al. (34) | RMD Open. (2018) | DAPSA and ultrasound show different perspectives of psoriatic arthritis disease activity: results from a 12-month longitudinal observational study in patients starting treatment with biological disease-modifying antirheumatic drugs. | DAPSA was not associated with US inflammatory findings which indicates that DAPSA and US may assess different aspects of PsA activity. |
| Alivernini et al. (51) | Ann Rheum Dis. (2017) | Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission? | PDUS-negative patients with RA in remission have comparable synovial histological features than PDUS-negative patients with RA in LDA. However, patients with PsA in remission are characterized by a higher degree of residual synovial inflammation than patients with RA in remission, despite PDUS negativity under TNF inhibition. |
| Ramírez et al. (52) | Clin Exp Rheumatol. (2017) | Differing local and systemic inflammatory burden in polyarticular psoriatic arthritis and rheumatoid arthritis patients on anti-TNF treatment in clinical remission. | Polyarticular PsA patients in remission had lower levels of local (US synovitis) and systemic inflammation than RA patients in remission, even though a significantly higher percentage of PsA patients were on tapered doses of anti-TNF, mainly in monotherapy. |
| Kampylafka et al. (36) | Arthritis Res Ther. (2018) | Resolution of synovitis and arrest of catabolic and anabolic bone changes in patients with psoriatic arthritis by IL-17A blockade with secukinumab: results from the prospective PSARTROS study. | Treatment with secukinumab led to significant improvement of signs and symptoms of PsA; 46% reached MDA and 52% DAPSA low disease activity. MRI synovitis (P = 0.034) and signal in PDUS (P = 0.030) significantly decreased after 24 weeks of treatment. Bone erosions in MRI and HR-pQCT and enthesiophytes in the HR-pQCT did not show any progression, and structural integrity and functional bone strength remained stable. |