Magnetic Resonance Imaging in Psoriatic Arthritis

A Descriptive Study of Indications, Features and Effect on Treatment Change

Hernán Maldonado-Ficco, MD; Barry J. Sheane, MB, MRCPI; Arane Thavaneswaran; Vinod Chandran, MD, DM, PhD, MBBS; Dafna D. Gladman, MD, FRCPC

Disclosures

J Clin Rheumatol. 2017;23(5):243-245. 

In This Article

Abstract and Introduction

Abstract

Objective: The aims of this study were to describe the indications for, and features of, axial/peripheral joint magnetic resonance imaging (MRI) in psoriatic arthritis (PsA) and to examine the influence of MRI findings on clinical practice.

Methods: All axial and peripheral (hand and/or foot) MRI scans on patients attending the Toronto PsA clinic l between 2003 and 2014 were included. Scan details were garnered from the radiologist's official report. A chart review was performed to determine if MRI findings contributed to a change of treatment.

Results: One hundred sixty-eight scans were performed on 125 patients (135 axial and 33 peripheral). The mean age was 50.5 (SD, 11.5) years, with 51.2% being female. Mean duration of PsA was 11.2 (SD, 10.9) years. Of the axial scans, the majority were performed on the whole spine (excluding the sacrum) (27.4%) or the sacroiliac joints and spine together (45.2%). The predominant indications were for suspected inflammatory (51.1%) or degenerative (24.4%) disease. Magnetic resonance imaging revealed inflammatory and/or structural change in 34.1% versus 54.8% with degenerative changes. In MRI axial inflammation (n = 25), the majority (48%) had sacroiliac joint involvement, whereas 28% had inflammation at 2 or more sites.

Of the periphery, 60.6% of scans were on hands and 21.2% were on feet alone. The main indications were for suspected subclinical synovitis (78.8%). Inflammatory arthritis was the MRI diagnosis in 72.7%. Magnetic resonance imaging findings influenced treatment change (n = 32) in 56.3%, but were insufficient to effect treatment change without clinical findings (100%).

Conclusions: Magnetic resonance imaging is useful in evaluating patients with active PsA, particularly when suspecting inflammation and radiographic findings are unhelpful. In some cases, it can be used as an adjunct to clinical examination in determining treatment change.

Introduction

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. It is included among the spondyloarthritis (SpA) group because of the presence of axial involvement and the shared extra-articular features. The clinical presentation of PsA is varied, involving axial and peripheral joints and periarticular structures such as entheses. Magnetic resonance imaging (MRI) is an important tool in the evaluation of patients with rheumatic diseases, particularly when radiographs do not demonstrate changes either in the peripheral joints or the axial skeleton.

The Assessment of SpondyloAthritis International Society has established classification criteria for patients with axial SpA, including patients with and without radiographic sacroiliitis.[1,2] Magnetic resonance imaging findings are diverse and in PsA include both peripheral and axial changes.[3] Magnetic resonance imaging can visualize peripheral and axial musculoskeletal anatomy and disease manifestations, including synovitis, enthesitis, tenosynovitis, tendonitis, peritendinitis, soft tissue edema, bone edema, bone erosion, and bone proliferation.[4–6] The MRI features in axial PsA are similar to those in ankylosing spondylitis, although more frequently asymmetric.[7] Whereas investigators have developed tools to score peripheral joints in rheumatoid arthritis and axial joints in ankylosing spondylitis, similar tools are lacking in PsA.

The aims of this study were to describe the indications for, and features of, axial and peripheral joint MRI in PsA and to examine the influence of MRI findings on change of treatment.

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