Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Ultrasound (US) and Rays (XR) Entheseal, Synovial and Sacroiliac Abnormalities in Early Psoriatic Arthritis (ePsA).

Bandinelli5,  Francesca, Bonciani3,  Diletta, Prignano3,  Francesca, Giovannini6,  Leonardo, Salvadorini6,  Giuliana, Collaku1,  Ledio, Candelieri4,  Antonio

Department of Internal Medicine of University of Tirana, Faculty of Medicine, Albania
Dermatology Unit, University of Florence, Italy
Dermatology Unit, University of Florence, Italy
Laboratory of Decision Engineering for Health Care Delivery, Department of Electronics, Informatics and Systems, University of Cosenza Italy
Rheumatology Division, University of Florence, Department of Biomedicine, Florence, Italy
Rheumatology Division, University of Florence, Department of Biomedicine, Florence, Italy


To investigate entheseal/synovial and sacroiliac abnormalities in ePsA respectively with ultrasound (US) and traditional × rays (XR) and the correlation with ePsA features (familiarity, psoriasis, inflammatory markers, HLA) useful for diagnosis.


92 ePsA patients (51±15 years old, 51 female and 41 male,), with duration of symthoms < 1 year, diagnosed according to CASPAR criteria (1) were consecutively studied with US (My Lab 70 XVG US Esaote 7–18 MHz linear array transducer) of entheses (Achilles, quadriceps, patellar and plantar fascia) and joints (radiocarpal, intercarpal, hands MCP, IFP and IFD, tibio-tarsal, feet MTP and IP) joints and with radiography (XR) of sacroiliac joints. Patients were scored respectively for entheses with Glasgow Ultrasound Enthesitis Scoring System (GUESS) (2) and Power Doppler signal (PD) (semiquantitative system, score 0–3), for peripheral joints with presence/absence of PD active synovitis, for sacroiliac joints with New York score (NYS) (3). We studied the correlation between GUESS and PD of entheses, active synovitis, NYS of sacroiliac joints with familiarity (for psoriasis and spondiloarthropathies), psoriasis area and severity Index (PASI), distribution -hand, feet, lower limbs- and characteristics -vulgaris, eritrodermic, pustulosus, guttata-, nail involvement, ESR, CRP, HLA aplotypes (B27, B35, B38, B39, CW6, CW7, DR4) were investigated.


Abnormalities are present in high percentage: in entheses (GUESS>1:100%, PD 40,2%), in peripheral joints (40,2% PD active synovitis), in sacroiliac joints (NYS>1: 25%). GUESS and PD of entheses correlated with the presence of lower limb psoriasis (respectively p<0,02, p<0,05, Mann Whitney test) but not with PASI and entheses PD with ESR (p<0,005) (linear correlation Pearson). GUESS was higher (p<0,05 Mann Whitney test) in CW6 positive patients (29,6%) but not other significant difference were found in other aplotypes. Synovitis and sacroileitis didn't correlate with familiarity, psoriasis, ESR/CRP, HLA.


In ePsA patients, entheseal and synovial US and sacroiliac XR modifications are present in high percentage. Our data clearly indicate that a thorough US and XR investigations must be always perform in early phase.

(1)Taylor, W, Gladman, D, Helliwell, Ph, Marchesoni, A, Mease, Ph & Mielants, H, and the CASPAR Study Group. Classification criteria for psoriatic arthritis. Development of new criteria from a large international study. Arthritis Rheum 2006;54:2665-73.

(2)Balint, P V, et al. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy Ann Rheum Dis 2002;61:905-910.

(3)van der Linden, S & Valkenburg, HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361-368.

To cite this abstract, please use the following information:
Bandinelli, Francesca, Bonciani, Diletta, Prignano, Francesca, Giovannini, Leonardo, Salvadorini, Giuliana, Collaku, Ledio, et al; Ultrasound (US) and Rays (XR) Entheseal, Synovial and Sacroiliac Abnormalities in Early Psoriatic Arthritis (ePsA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1962
DOI: 10.1002/art.29727

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