Abstract
Introduction. Inflammatory arthritis, including rheumatoid arthritis (RA) and psoriatic arthritis (PsA), presents with overlapping clinical manifestations, making early differentiation crucial for effective treatment. Musculoskeletal ultrasonography has emerged as a sensitive imaging tool for detecting early inflammatory and structural changes, aiding in precise diagnosis.
Objective. This study aims to identify specific musculoskeletal ultrasonography parameters distinguishing RA, PsA, and psoriasis (PsO), facilitating early diagnosis and optimizing therapeutic strategies.
Methods. A cross-sectional study was conducted on 274 patients diagnosed with inflammatory musculoskeletal diseases, categorized into three groups: 127 PsA, 91 RA, and 56 PsO patients. All participants underwent clinical and ultrasonographic assessment, evaluating synovial hypertrophy, joint effusions, tenosynovitis, enthesitis, and bone erosions using Gray Scale and Power Doppler techniques. Statistical analysis was performed using SPSS 26.0.
Results. Musculoskeletal ultrasonography revealed significant differences between PsA, RA, and PsO. Synovial hypertrophy and bone erosions were predominant in RA (75.67%) and PsA (48.48%), with tenosynovitis affecting flexor tendons in PsA and extensor tendons in RA. Subclinical enthesitis was present in 72.72% of PsA patients and 45% of PsO patients, while radiocarpal joint effusions were more common in RA (59%). PsO patients exhibited mild, subclinical changes, with 40% showing early synovio-entheseal inflammation.
Conclusions. Musculoskeletal ultrasonography is a valuable tool for the early differentiation of inflammatory arthritis types, allowing detection of subclinical enthesitis and tenosynovitis in PsA, as well as progressive synovial hypertrophy and erosions in RA. Periodic musculoskeletal ultrasonography monitoring in PsO patients may help predict PsA onset, improving early intervention strategies.