Ultrasonographic wrist and hand abnormalities in early psoriatic arthritis patients: correlation with clinical, dermatological, serological and genetic indices.

ABSTRACT

OBJECTIVES: The aims of our study are to describe the wrist and hand ultrasound (US) abnormalities compared to clinical examination in early psoriatic arthritis (ePsA) and to analyse their correlation with clinical, dermatological, serological and genetic indices. METHODS: We analysed 1120 fingers and 224 wrists of 112 early PsA, with MyLab70 Xview (Esaote, linear probe) ultrasound (US). Power Doppler active synovitis (AS), erosions, finger tendons tenosynovitis or peritendinitis (TP) and pseudotenosynovitis (PT), were compared to clinical (BASDAI, SHAQ), dermatological (PASI and psoriasis aspects), serological (ESR, CRP, ACPA) and genetic (HLA haplotypes) indices. RESULTS: All US abnormalities were present AS was more frequent at wrists (50/224 [22.3%]), followed by hand PT (68/1120 [6,1%]) and TS (29/1120 [2.6%]), while erosions were rare (10/1120 [0.8%]). US abnormalities were independent of ePsA clinical indices (except erosions - even if represented only in a low percentage - that correlated to BASDAI [p<0.05]), while they were associated to several dermatological (except PASI), serological and genetic parameters psoriasis (all p<0.0001), palmoplantar psoriasis (wrist and hand AS p<0.0005 and p<0.005, respectively), hand psoriasis (all p<0.0001), nail dystrophy (hand AS p<0.05, PT p<0.0001, erosions p<0.0001); positive CRP (all p<0.0001), ESR (wrist and hand AS p<0.005 and <0.0005, respectively, TS, PT and erosions p<0.0001) and ACPA - even if represented only in 1.78% of patients - (wrist and hand AS and TS p<0.0001, PT p<0.5); HLA-B27 (wrist and hand AS p<0.0001, TS p<0.01, PT p<0.05), -B35 (wrist and hand AS p<0.01 and p<0.05, respectively), -B38 (wrist and hand AS p<0.0001, TS p<0.0001, PT p<0.005), -CW6 (wrist AS p<0.05), -DR4 (wrist and hand AS p<0.0001, TS p<0.0001, PT p<0.005). CONCLUSIONS: US abnormalities of hand and wrist were independent of clinical ePsA indices (except erosions), while they correlated to dermatological (except PASI), serological and genetic parameters of disease.