Multimodal imaging of the distal interphalangeal-joint synovio-entheseal complex in psoriatic arthritis (MIDAS): a cross-sectional study on the diagnostic accuracy of different imaging modalities comparing psoriatic arthritis to psoriasis and osteoarthritis

Jorgen Guldberg-Moller*, Mette Mogensen, Karen Ellegaard, Ali Zavareh, Richard J. Wakefield, Ai Lyn Tan, Mikael Boesen, Jamshid Dehmeshki, Olga Kubassova, Lene Dreyer, Marius Henriksen, Lars Erik Kristensen

*Corresponding author for this work

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Abstract

Objective Can ultrasound (US), MRI and X-ray applied to the distal interphalangeal (DIP)-joint and synovio-entheseal complex (SEC) discriminate between patients with psoriatic arthritis (PsA), skin psoriasis (PsO) and hand osteoarthritis (OA)? Methods In this prospective, cross-sectional study, patients with DIP-joint PsA and nail involvement (n=50), PsO with nail involvement (n=12); and OA (n=13); were consecutively recruited. Risk ratios (RR) were calculated for US, MRI and X-ray findings of the DIP-joint and SEC between diagnoses. Results New bone formation (NBF) in US and MRI was a hallmark of OA, reducing the risk of having PsA (RR 0.52 (95% CI 0.43 to 0.63) and 0.64 (95% CI 0.56 to 0.74). The OA group was different from PsA and PsO on all MRI and X-ray outcomes reflected in a lower RR of having PsA; RR ranging from 0.20 (95% CI 0.13 to 0.31) for MRI bone marrow oedema (BMO) to 0.85 (95% CI 0.80 to 0.90) in X-ray enthesitis. No outcome in US, MRI or X-ray was significantly associated with a higher risk of PsA versus PsO, although there was a trend to a higher degree of US erosions and NBF in PsA. 82% of PsA and 67% of PsO was treated with disease modifying antirheumatic drugs which commonly reflects the clinical setting. Conclusion High grade of US, MRI and X-ray NBF reduce the RR of having PsA compared with OA. In PsA versus PsO patients, there was a trend for US to demonstrate more structural changes in PsA although this did not reach significance.

Original languageEnglish
Article number002109
JournalRMD Open
Volume8
Issue number1
Number of pages10
ISSN2056-5933
DOIs
Publication statusPublished - Mar 2022

Keywords

  • Psoriatic Arthritis
  • Magnetic Resonance Imaging
  • Ultrasonography
  • Osteoarthritis
  • HAND OSTEOARTHRITIS
  • NAIL
  • PREVALENCE
  • ENTHESITIS
  • INVOLVEMENT
  • SPONDYLOARTHRITIS
  • CLASSIFICATION
  • EPIDEMIOLOGY
  • INFLAMMATION
  • RELIABILITY

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