Achilles tendon ultrasonography may detect early features of psoriatic arthropathy

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This study suggests the use of ultrasonography to the Achilles’ tendon in early diagnosis of psoriatic arthropathy with the aim of preventing the progression of the pathology could be beneficial.

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Background:
Psoriatic Arthropathy is a progressive and debilitating disease which involves a reduction of the functional activity of the articulations with consequent deterioration of the patient's quality of life. The entheses represent the initial site of articular inflammation and the enthesis of the Achilles’ tendon is the first to be affected. In some patients with psoriasis, enthesitis may not be diagnosed because it is still asymptomatic.

Objective:
To evaluate whether ultrasonography may allow early diagnosis in a larger population and identify significant alterations of enthesitis beyond increased of thickness of the Achilles tendon.

Materials and Methods:
The study was undertaken on 59 patients (16 women, 43 men), affected by chronic plaque psoriasis and 59 patients suffering from other dermopathies. The patients underwent echographic evaluation, adopting Voluson, utilizing 12-MHz linear transducer on the Achilles’ heel. The severity of the psoriasis was evaluated by PASI, the enthesitis by the Glasgow Ultrasound Enthesitis Scoring System (GUESS).

Results:
The GUESS score resulted higher in those patients with psoriasis compared to patients suffering from other dermopathies. 22.03% of psoriatic patients (13 out of 59) presented over 5.29 mm tendon thickness and irregular tendon structure. In 12 patients there were also other abnormalities affecting the tendon. In seven patients (11.9%) bursitis was also revealed.

Conclusions:
Our data confirm that ultrasonography is a sensitive technique which reveals enthesitis more frequently than clinical examination in patients affected by psoriasis. We, therefore, suggest the use of ultrasonography to the Achilles’ tendon in early diagnosis of psoriatic Arthropathy with the aim of preventing the progression of the pathology.

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