Musculoskeletal ultrasonography and hematological indices in the detection of subclinical arthritis and enthesitis in patients with psoriasis

Background: Psoriasis is a chronic inflammatory skin disease associated with systemic involvement, including psoriatic arthritis (PsA). Early detection of subclinical musculoskeletal changes is essential to prevent joint damage and disability. Musculoskeletal ultrasonography (MSUS) and hematological inflammatory indices may serve as effective tools for identifying early inflammatory changes in psoriasis patients without clinical arthritis. Objectives: To evaluate the role of musculoskeletal ultrasonography and hematological indices in detecting subclinical arthritis and enthesitis in patients with psoriasis. Patients and methods: A case-control study was conducted involving 100 patients with chronic plaque psoriasis and 50 healthy age- and sex-matched controls. All participants underwent detailed clinical assessment and laboratory investigations, including complete blood count. Psoriasis patients were evaluated using high-resolution musculoskeletal ultrasound to detect subclinical arthritis and enthesitis, according to OMERACT and GUESS scoring systems. Based on MSUS findings, patients were categorized into groups with and without subclinical musculoskeletal involvement. Results: Subclinical musculoskeletal involvement was detected in 42% of psoriasis patients. Among them, 26% had subclinical enthesitis, 12% had subclinical arthritis, and 4% had both. The most frequently affected enthesis was the Achilles tendon, while the knee was the most commonly involved joint. Additionally, these patients had significantly longer psoriasis duration and higher PASI scores (p < .05). Conclusion: Musculoskeletal ultrasonography is a sensitive and non-invasive modality for detecting subclinical arthritis and enthesitis in psoriasis patients. Early detection may allow for timely therapeutic intervention, potentially preventing irreversible joint damage.