The thickening of flexor tendons pulleys: a useful ultrasonographical sign in the diagnosis of psoriatic arthritis

Congress:

ECR 2018

Poster Number:

C-0309

Type:

Scientific Exhibit

Keywords:

Musculoskeletal joint, Musculoskeletal soft tissue, Extremities, Ultrasound, Ultrasound-Power Doppler, Diagnostic procedure, Arthritides, Connective tissue disorders, Inflammation

Authors:

A. Furlan, A. Merola, A. Kuate Nogha, D. Simonato, I. Gigantelli, R. Stramare; Padova/IT

DOI:

10.1594/ecr2018/C-0309

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0309

Fig. 1: The A1 pulley. A: the A1 pulley scheme. T: flexor tendons (superficial and...

Fig. 3: Frequency of the thickening of the pulleys in different final diagnosis...

Aims and objectives

To investigate the frequency of flexor tendons pulleys thickening in patients with hand early arthritis and to evaluate it as a predictive sign of PsA.

Methods and materials

A prospective observational study was conducted in 228 consecutive patients presenting with recent onset of hands arthritis at some Rheumatology outpatient clinics in the Veneto region (Italy) between December 2012 and October 2015. The diabetic patients were excluded because of the high frequency of trigger finger. The final diagnosis of the rheumatologist after a 12-month follow-up was compared as the gold standard.

Results

Twenty-two patients were excluded from the study because of diabetics. A total of 86 patients with thickening of flexor tendons A1 pulleys and 120 without were evaluated. The pulley thickness was significantly associated with the family history of psoriasis (18/86 vs 3/120, p˂0.001) and diabetes (9/86 vs 4/120, p = 0.036), with personal history cutaneous psoriasis (25/86 vs 10/120, p˂0.001), psoriatic onychopathy (7/86 vs 2/120, p=0.028), low back pain (22/86 vs 11/120, p=0.001), Dupuytren's disease (7/86 vs 2/120 p=0.028) and De Quervain tenosynovitis (4/86 vs...

Conclusion

The thickening of the flexor tendons pulleys is easy to detect sign with a good sensitivity for the diagnosis of PsA. The specificity and the positive predictive value wasn’t very high, however, if included in a complete classification process, sonographers should search and report it during the hand evaluation of patients with arthritis.

Personal information

Antonio FurlanMD, PhD Institute of Radiology, Department of Medicine, University of Padua ORCID ID: 0000-0002-8409-5603

References

1. Rudwaleit M (2010) New approaches to diagnosis and classification of axial and peripheral spondyloarthritis. Curr Opin Rheumatol 22 (4):375-380. doi:10.1097/BOR.0b013e32833ac5cc 2. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54 (8):2665-2673. doi:10.1002/art.21972 3. Tan AL, Fukuba E, Halliday NA, Tanner SF, Emery P, McGonagle D (2015) High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum...