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Clues to the Pathogenesis of Psoriasis and Psoriatic Arthritis from Imaging: A Literature Review
This article summarizes a presentation on imaging of skin and joints in patients with psoriasis and psoriatic arthritis (PsA) from the 2007 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Plain radiography provides valuable insights into the pat...
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Published in: | Journal of rheumatology 2008-07, Vol.35 (7), p.1438-1442 |
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Main Authors: | , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Online Access: | Get full text |
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Summary: | This article summarizes a presentation on imaging of skin and joints in patients with psoriasis and psoriatic arthritis (PsA)
from the 2007 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Plain
radiography provides valuable insights into the pathogenesis of PsA but is limited because only calcified tissue can be imaged.
Newer techniques such as magnetic resonance imaging (MRI) and ultrasound (US) provide additional clues to the pathogenesis
of this peripheral, axial, and dermatologic disease. MRI and to a lesser extent US allow visualization of articular and periarticular
structures, showing widespread juxtaarticular inflammation in PsA. Bone edema, a surrogate marker of inflammation, can occur
throughout the digit in psoriatic dactylitis. Localization of inflammatory change at the juxtaarticular entheses suggests
this as the primary site of inflammation. Recent imaging studies provide insights into the relationship between nail and articular
disease, demonstrating extension of inflammation from entheseal structures at the distal interphalangeal joint to the nail
bed, but the temporal or anatomical progression of these changes remains elusive. Imaging of the skin lags behind that of
the articular structures, partly because the skin is readily available for biopsy; however, newer techniques such as laser
Doppler imaging provide insights into angiogenesis at the advancing edge of psoriatic plaques. Future work will explore the
relationship between immunohistology and imaging of skin and joints. Improvements in imaging articular soft tissues with ultra-short
echo time MRI and skin with multi-photon fluorescence microscopy promise insights into anatomical and functional changes.
Key Indexing Terms:
PSORIATIC ARTHRITIS
PSORIASIS
DACTYLITIS
ENTHESITIS
NAIL PSORIASIS |
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ISSN: | 0315-162X 1499-2752 |