TY - JOUR
T1 - Ultrasound in the Management of Patients With Psoriatic Arthritis
T2 - Systematic Literature Review and Novel Algorithms for Pragmatic Use
AU - Gouze, Hélène
AU - Backhaus, Marina
AU - Balint, Peter
AU - Matteo, Andrea Di
AU - Grassi, Walter
AU - Iagnocco, Annamaria
AU - Naredo, Esperanza
AU - Wakefield, Richard J.
AU - Østergaard, Mikkel
AU - Emery, Paul
AU - D’Agostino, Maria Antonietta
N1 - Publisher Copyright:
© 2024 The Journal of Rheumatology.
PY - 2024
Y1 - 2024
N2 - Objective. In 2015, the European Alliance of Associations for Rheumatology (EULAR) published recommendations for the use of imaging for the diagnosis and management of spondyloarthritis (SpA) in clinical practice. These recommendations included the use of ultrasound (US) in patients with psoriatic arthritis (PsA), but the management was not clearly distinguished from that of SpA. We aimed to systematically review the literature on the role of US for the management of PsA, and to propose pragmatic algorithms for its use in clinical practice. Methods. A group of 10 rheumatologists, experienced in imaging and musculoskeletal US, met with the objectives of formulating key questions for a systematic literature review (SLR), appraising the available evidence, and then proposing algorithms on the application of US in suspected or established PsA, based on both the literature and experts’ opinions following a Delphi process. Results. The SLR included 120 articles, most of which focused on the diagnostic process. The elevated number of articles retrieved suggests the interest of rheumatologists in using US in the management of PsA. After a consensual discussion on literature data and expert opinion, the following 3 algorithms were developed to be used in practical situations: suspicion of PsA, management of PsA with good clinical response, and management of PsA with insufficient clinical response. Conclusion. The SLR showed interest by rheumatologists in using US to objectively evaluate PsA for diagnosis and management. We propose 3 practical algorithms to guide its use in the clinical management of patients, from diagnosis to the assessment of treatment response. Further studies are needed to define remission and to assess the ability of US to predict disease severity.
AB - Objective. In 2015, the European Alliance of Associations for Rheumatology (EULAR) published recommendations for the use of imaging for the diagnosis and management of spondyloarthritis (SpA) in clinical practice. These recommendations included the use of ultrasound (US) in patients with psoriatic arthritis (PsA), but the management was not clearly distinguished from that of SpA. We aimed to systematically review the literature on the role of US for the management of PsA, and to propose pragmatic algorithms for its use in clinical practice. Methods. A group of 10 rheumatologists, experienced in imaging and musculoskeletal US, met with the objectives of formulating key questions for a systematic literature review (SLR), appraising the available evidence, and then proposing algorithms on the application of US in suspected or established PsA, based on both the literature and experts’ opinions following a Delphi process. Results. The SLR included 120 articles, most of which focused on the diagnostic process. The elevated number of articles retrieved suggests the interest of rheumatologists in using US in the management of PsA. After a consensual discussion on literature data and expert opinion, the following 3 algorithms were developed to be used in practical situations: suspicion of PsA, management of PsA with good clinical response, and management of PsA with insufficient clinical response. Conclusion. The SLR showed interest by rheumatologists in using US to objectively evaluate PsA for diagnosis and management. We propose 3 practical algorithms to guide its use in the clinical management of patients, from diagnosis to the assessment of treatment response. Further studies are needed to define remission and to assess the ability of US to predict disease severity.
KW - arthritis
KW - psoriasis
KW - psoriatic arthritis
KW - ultrasonography
U2 - 10.3899/jrheum.2023-0091
DO - 10.3899/jrheum.2023-0091
M3 - Review
C2 - 37714552
AN - SCOPUS:85181567108
VL - 51
SP - 50
EP - 60
JO - Journal of Rheumatology
JF - Journal of Rheumatology
SN - 0315-162X
IS - 1
ER -