SP0075 Linking Histology and Imaging in The Pathogenesis of Psa
Authors: E. Filippucci
Journal: Annals of the Rheumatic Diseases (2016)

Psoriatic arthritis (PsA) is a chronic inflammatory disease with a wide and heterogeneous spectrum of pathologic conditions including intra-articular and peri-tendinous synovitis, enthesitis, psoriatic plaque and onycopathy (1). Since angiogenesis plays a key role in the pathogenesis of both synovial tissue and skin involvement, the term "psoriatic disease" has been introduced to underline that the disease has the potential to affect different tissues (2). Technological advances are constantly improving the diagnostic ability of the imaging modalities, especially of ultrasound and magnetic resonance imaging, opening new sceneries in the research field (3–11). The recent availability of an ultrasound probe with a B-mode frequency reaching 22 MHz allows for a detailed morpho-structural assessment together with a highly sensitive detection of blood flow in small vessels of superficial tissues. This is of particular interest, considering that most of the PsA targets are superficial tissues. The main aims of this presentation are to discuss the most relevant investigations aiming at assessing the role of histology and imaging in PsA, and to show the diagnostic ability of the last generation imaging modalities in the evaluation of the main PsA targets (i.e. joint, tendon, enthesis, skin, and nail). <h3>References</h3> Coates LC, Anderson RR, Fitzgerald O, Gottlieb AB, Kelly SG, Lubrano E, McGonagle DG, Olivieri I, Ritchlin CT, Tan AL, De Vlam K, Helliwell PS. Clues to the pathogenesis of psoriasis and psoriatic arthritis from imaging: a literature review. J Rheumatol 2008;35:1438–42 Gutierrez M, Filippucci E, De Angelis R, Filosa G, Kane D, Grassi W. A sonographic spectrum of psoriatic arthritis: "the five targets". Clin Rheumatol 2010;29:133–42 Aydin SZ, Bas E, Basci O, Filippucci E, Wakefield RJ, Celikel C, Karahan M, Atagunduz P, Benjamin M, Direskeneli H, McGonagle D. Validation of ultrasound imaging for Achilles entheseal fibrocartilage in bovines and description of changes in humans with spondyloarthritis. Ann Rheum Dis 2010;69:2165–8. Filippucci E, De Angelis R, Salaffi F, Grassi W. Ultrasound, skin, and joints in psoriatic arthritis. J Rheumatol Suppl. 2009;83:35–8. McGonagle D, Ash Z, Dickie L, McDermott M, Aydin SZ. The early phase of psoriatic arthritis. Ann Rheum Dis 2011;70 Suppl 1:i71–6. McGonagle D, Aydin SZ, Tan AL. The synovio-entheseal complex and its role in tendon and capsular associated inflammation. J Rheumatol Suppl 2012;89:11–4. Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GA, Filippucci E, Gandjbakhch F, Mandl P, Pineda C, Schmidt WA, D9Agostino MA; Outcome Measures in Rheumatology Ultrasound Task Force. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014;66:741–8. Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W. Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 2011;70:1111–4. Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, Filippucci E, Grassi W. Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxford). 2012;51:1261–8. Gutierrez M, De Angelis R, Bernardini ML, Filippucci E, Goteri G, Brandozzi G, Lemme G, Campanati A, Grassi W, Offidani A. Clinical, power Doppler sonography and histological assessment of the psoriatic plaque: short-term monitoring in patients treated with etanercept. Br J Dermatol. 2011 Jan;164(1):33–7. Grassi W, Gutierrez M, Filippucci E. The sound of enthesis. J Rheumatol 2010;37:1986–8. <h3>Disclosure of Interest</h3> None declared