Psoriatic arthritis - PubMed (original) (raw)

Psoriatic arthritis

Artur Jacek Sankowski et al. Pol J Radiol. 2013 Jan.

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. It is characteristic that the rheumatoid factor in serum is absent. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also complex. Inflammation is caused by immunological reactions leading to release of kinins. Destructive changes in bones usually appear after a few months from the onset of clinical symptoms. Typically PsA involves joints of the axial skeleton with an asymmetrical pattern. The spectrum of symptoms include inflammatory changes in attachments of articular capsules, tendons, and ligaments to bone surface. The disease can have divers clinical course but usually manifests as oligoarthritis. Imaging plays an important role in the diagnosis of PsA. Classical radiography has been used for this purpose for over a hundred years. It allows to identify late stages of the disease, when bone tissue is affected. In the last 20 years many new imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance (MR), have been developed and became important diagnostic tools for evaluation of rheumatoid diseases. They enable the assessment and monitoring of early inflammatory changes. As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided.

Keywords: genetics and immunology of psoriatic arthritis; imaging studies; psoriatic arthritis; spondyloarthropathies.

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Figures

Figure 1.

Figure 1.

X-ray of the heel: Destructive changes at the sight of calcaneal tendon attachment due to inflammation.

Figure 2.

Figure 2.

X-ray of feet: The destructive form of psoriatic arthritis (arthritis mutilans). Numerous destructive changes in matacarpophalangeal and intrerphalangeal joints.

Figure 3.

Figure 3.

X-ray of hands: The destructive form of psoriatic arthritis (arthritis mutilans). Numerous destructive changes in joints of both hands. Ankylosis of the right wrist. Typical for PsA changes called “pencil-in-cup” involving metacarpophalangeal joints.

Figure 4.

Figure 4.

Inflammatory changes in sacroiliac joints. Marked asymmetry with more prominent erosions on the left side.

Figure 5.

Figure 5.

X-ray of sacroiliac joints and lumbar spine. Marked asymmetry of symptoms is visible.

Figure 6.

Figure 6.

X-ray of intrerphalangeal joints of the hand. Minor erosive changes involving distal interphalangeal joints.

Figure 7.

Figure 7.

Patient with PsA – X-ray of forefoot. Shows a form of the disease involving distal interphalangeal joints. Margin erosions and periostosis in DIP joint of the first finger of the left foot are visible.

Figure 8.

Figure 8.

X-ray of hands: Ankylosis of the left wrist in a patient with the late stage of PsA.

Figure 9.

Figure 9.

Hand X-ray examination: Superimposed degenerative and inflammatory changes in the course of psoriatic arthritis involving the interphalyngeal joints.

Figure 10.

Figure 10.

The US examination in a grey scale, longitudinal plane. Investigation of the second matacarpophalangeal joint. Erosion and inflammatory changes presenting as a synovium hypertrophy.

Figure 11.

Figure 11.

US examination in the same patient (Figure 7). Effusion, hypertrophy and hyperaemia of synovial membrane with erosions in interphalangeal joint of the left hallux.

Figure 12.

Figure 12.

US examination Power Doppler of the proximal phalanx of the II finger, volar side. Inflammatory changes in the tendon sheath of the flexor muscle of the fingers. Joint effusion, synovial membrane hypertrophy and hyperaemia in PD.

Figure 13.

Figure 13.

MR examination of the joints of the wrist. STIR images. The distal radio-ulnar joint effusion, less prominent in intercarpal joints.

Figure 14.

Figure 14.

Whole body Scintigraphy (of skeleton) of a patient with PsA. Numerous joints of axial and peripheral skeleton involved in the process.

Figure 15.

Figure 15.

Scintigraphy of hands and forearms. Radionuclide accumulation in the joints of the wrist, metacarpophalangeal and interphalangeal joints involved in the inflammatory process.

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