Drs. Freeston and Coates and Drs. Helliwell and Conaghan contributed equally to this work.
Is There Subclinical Synovitis in Early Psoriatic Arthritis? A Clinical Comparison With Gray-Scale and Power Doppler Ultrasound†
Article first published online: 24 FEB 2014
© 2014 The Authors. Arthritis Care & Research is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Arthritis Care & Research
Volume 66, Issue 3, pages 432–439, March 2014
How to Cite
Freeston, J. E., Coates, L. C., Nam, J. L., Moverley, A. R., Hensor, E. M. A., Wakefield, R. J., Emery, P., Helliwell, P. S. and Conaghan, P. G. (2014), Is There Subclinical Synovitis in Early Psoriatic Arthritis? A Clinical Comparison With Gray-Scale and Power Doppler Ultrasound. Arthritis Care Res, 66: 432–439. doi: 10.1002/acr.22158
ClinicalTrials.gov identifier: NCT01106079. ISRCTN: 30147736.
- Issue published online: 24 FEB 2014
- Article first published online: 24 FEB 2014
- Accepted manuscript online: 10 SEP 2013 03:31PM EST
- Manuscript Accepted: 3 SEP 2013
- Manuscript Received: 22 MAR 2013
- Arthritis Research UK (Clinician Scientist). Grant Number: 19335
- Arthritis Research UK (Clinical Research Fellow). Grant Number: 18364
- Arthritis Research UK. Grant Number: 18825
Arthritis activity assessments in psoriatic arthritis (PsA) have traditionally relied on tender and swollen joint counts, but in rheumatoid arthritis, multiple studies have demonstrated subclinical inflammation using modern imaging. The aim of this study was to compare clinical examination and ultrasound (US) findings in an early PsA cohort.
Forty-nine disease-modifying antirheumatic drug–naive patients with recent-onset PsA (median disease duration 10 months) underwent gray-scale (GS) and power Doppler (PD) US of 40 joints plus tender and swollen joint counts of 68/66 joints. GS and PD were scored on a 0–3 semiquantitative scale for each joint. Clinically active joints were defined as tender and/or swollen and US active joints were defined as a GS score ≥2 and/or a PD score ≥1.
The most common sites for subclinical synovitis were the wrist (30.6%), knee (21.4%), metatarsophalangeal (MTP) joints (26.5–33.7%), and metacarpophalangeal joints (10.2–19.4%). Excluding MTP joints and ankles, 37 (75.5%) of 49 patients had subclinical synovitis with a median of 3 (interquartile range [IQR] 1–4) joints involved. In contrast, clinical overestimation of synovitis occurred most commonly at the shoulder (38%) and ankle (28.6%). Twelve of 49 patients were classified clinically as having oligoarthritis; of these, subclinical synovitis identified 8 (75%) as having polyarthritis with an increase in their median joint count from 3 (IQR 1–4) to 6 (IQR 5–7).
This study has demonstrated that subclinical synovitis, as identified by US, is very common in early PsA and led to the majority of oligoarthritis patients being reclassified as having polyarthritis. Further research is required into the relationship of such subclinical synovitis to structural progression.