Detection of asymptomatic enthesopathy by ultrasonography in psoriatic patient

Background: The psoriatic arthritis considered a commonest related systemic ‌symptom of psoriasis and asymmetric oligoarthritis of the smaller joints of the feet ‌and hands being the major presentation. ‌Aim of the study: to study value of musculoskeletal (MSK) ultrasonography of ‌small enthesis of the hands in detection of asymptomatic enthesopathies in patient ‌with psoriasis. ‌Patients and Methods: This is a cross-sectional analytic study included 35patients ‌of either gender (16 Male, 19 Female) with confirmed diagnosis of psoriasis. The high-‌resolution MSK ultrasound assessment was performed and three entheses of hand ‌‌(EDP, FDS, and EPB) were scanned in longitudinal and axial planes‌Results: MSK ultrasonography of hand entheses shows enthesitis in 68.5% of ‌psoriatic patients and 43.8% of total entheses sites.‌The most frequently involved enthesis site was proximal insertion of Extensor ‌digitorum communis tendon (EDC) followed by proximal insertion of FDS and EPB ‌tendons. The ultrasound element of hypoechogenicity was the most frequently ‌noticed followed by enthesophytes, calcification, entheseal thickening, least likely ‌seen parameter was bony erosion. No power Doppler vascularity was seen in all ‌examined enthesis sites.‌Conclusions: Ultrasound examination of functional entheses at hand level is a ‌useful tool in detection of subclinical abnormalities of psoriatic arthropathy. ‌Ultrasound images can clearly documented elementary component of ‌enthesopathy inform of hypoechogenicity, calcification, tendon thickening ‌enthesophyte, and bony entheseal erosions.‌