Original articleExtrasynovial ultrasound abnormalities in the psoriatic finger. Prospective comparative power-doppler study versus rheumatoid arthritis
Introduction
The fingers are common sites of involvement in both rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The synovial membrane of the joints and tendon sheaths is affected in both conditions. Selective involvement of the distal fingers consistent with enthesitis, in contrast, occurs in PsA but not in RA [1], [2]. We used ultrasonography to look for evidence of finger enthesitis in PsA, comparatively with RA. Ultrasonography is a simple and noninvasive tool capable of imaging the bone contours, synovial membrane, tendons, and soft tissues.
Section snippets
Methods
We prospectively included 21 patients meeting American College of Rheumatology criteria for RA [3] and 20 patients meeting Fournié criteria for PsA [4]. In the RA group, there were 16 women and five men (ratio, 3.2) with a mean age of 52.9 years and mean disease duration of 10.5 years. The PsA group comprised nine women and 11 men (ratio, 0.8) with a mean age of 42.8 years and mean disease duration of 90.3 years. The inclusion criterion was presence of symptoms in one or more fingers, without
Results
We studied 25 fingers in the 21 patients with RA (one finger in 18 patients, two in two patients, and three in one patient) and 25 fingers in the 20 patients with PsA (one finger in 15 patients and two in five patients) (Table 1).
Synovial abnormalities were consistently seen in the fingers with RA (Fig. 1, Fig. 2). A close correlation was noted in the RA group between the clinical manifestations and the ultrasound findings. A positive Doppler signal from foci of synovitis was found in eight
Discussion
Ultrasound imaging detected extrasynovial abnormalities that may be specific of PsA of the fingers. In keeping with earlier publications [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], we found no extrasynovial abnormalities in the fingers with RA. In a study of ultrasound imaging of the distal phalanx in patients with various rheumatic diseases, Grassi et al. [16] noted abnormal signals at the site of flexor tendon attachment in patients with PsA. Jevtic et al. [17] used magnetic
Conclusion
The findings from this study support the concept that PsA of the finger results both in synovial membrane abnormalities that resemble those seen in RA (erosive synovitis and tenosynovitis) and in enthesopathy of the fibrous skeleton of the finger. The involvement of the fibrous skeleton distinguishes clearly PsA from RA of the finger.
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