Comparative characterization of the data of magnetic resonance imaging, X-ray and clinical studies of the hand and foot joints in patients with early psoriatic arthritis

The clinical manifestations of psoriatic arthritis (PsA) at its early stage may be inadequately informative. In this connection, radiological techniques, such as magnetic resonance imaging (MRI) and X-ray study of peripheral joints, in addition to clinical examination are of paramount importance in the diagnosis of early PsA. Objective: To compare the data of clinical examination and various imaging methods (MRI and X-ray) of the hand and foot joints in early peripheral PsA. Subjects and methods. The trial included 45 patients (14 men and 31 women; mean age 42.08±13.7 years; median PsA duration 1 year [range 0.55 to 2]) with early peripheral PsA without previous therapy with disease-modifying antirheumatic drugs (DMARDs), who met the CASPAR criteria (2006). A standard clinical examination was performed and the activity of peripheral arthritis and the presence of enthesitis and dactylitis were determined in the patients. Not later than 2 days after the clinical examination, a standard X-ray examination of the hands and feet in the direct projection and MRI of the same areas were made. Results. When included into the study, the entire group of patients was found to have a moderate PsA by DAS; its median was 3.12 [2.21 to 3.89]. Cutaneous PsA was noted in 40 patients; 5 persons had a family history of PsA; one female patient had ungual PsA only. In the study group, the clinical signs of enthesitis in the tendon attachments at different sites were revealed in 33 (75.3%) patients. Dactylitis was found in 34 (75%) patients. The clinical examination showed inflammatory changes in the hand and foot joints in 36 (80%) and 38 (84%) patients, respectively; while MRT revealed them in 31 (69%) and 32 (71%) patients. Hand MRI displayed arthritis of the proximal interpha-langeal (PIP), metacarpophalangeal (MCP), and distal interphalangeal (DIP) joints in 27 (87%), 21 (68%), and 12 (40%) of the 31 patients, respectively. Foot MRI exhibited MCP, PIP, and DIP joint arthritis in 26 (81%), 21 (66%), and 18 (56%) of the 32 patients, respectively. MRI revealed axial injury of the finger and toe joints in 45% (14/31) and 15.6% (5/32). The clinical examination established finger and toe flexor tenosynovitis in 17 (37.7%) and 5 (11%) patients, respectively; whereas MRI detected them significantly more frequently in 22 (48.8%) and 24 (53.3%) patients (Fisher test; p = 0.035). X-ray study disclosed erosions of hand and foot joint surfaces in 20% and during MRI this indicator was significantly higher than 24.4% (Fisher test; p = 0.022). Conclusion. The findings suggest that MRI of the hand and foot joints is one of the modalities to improve the early diagnosis of PsA. It can effectively reveal soft tissue pathology characteristic for this disease, as well as destructive changes in the hand and foot joints.

psoriatic arthritis, magnetic resonance imaging, dactylitis

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