Ultrasonography Greatly Improves the Ability of Clinicians to Diagnose Psoriatic Arthritis

摘要

Approximately 7%–42% of patients with psoriasis, a chronic autoimmune skin condition, suffer from a complication known as psoriatic arthritis.[ ] The large deviation in the reported prevalence of psoriatic arthritis is largely due to the difference in diagnostic methodology used by clinicians. Conventionally, arthritis has been diagnosed using a physical examination, which is limited by the practitioner's sense of touch. The physical examination has low sensitivity and often underestimates the prevalence of arthritis.[ ] Currently, the diagnosis of psoriatic arthritis is primarily made using the ClASsification criteria for Psoriatic ARthritis (CASPAR) criteria. The CASPAR criteria establish the diagnosis of psoriatic arthritis based on the presence of inflammatory articular disease (synovitis, enthesitis, or spondylitis) and a score of at least three points assessed in the following five items: psoriasis (up to 2 points), nail abnormalities (1 point), dactylitis (1 point), negative rheumatoid factor (1 point), and juxta-articular new bone formation on radiographic film (1 point).[ ] The key to whether patients with psoriasis can be diagnosed with psoriatic arthritis at an early stage is the ability of the clinician to discover the presence of arthritis. Breakthroughs in the technology used to support clinicians in the early diagnosis of arthritis are needed. In 2011, Naredo used ultrasound to study patients with psoriasis without joint symptoms and discovered that 50.7% of patients demonstrated ultrasonographic synovitis, whereas 62.5% of patients demonstrated ultrasonographic enthesitis. This suggests that ultrasound is a more sensitive diagnostic method than physical examination for the detection of synovitis and enthesitis at an early stage.[ ]