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3T MRI of Flexor Tendon Pulleys May Be Useful to Detect, Monitor PsA

Using 3-tesla magnetic resonance imaging (3T MRI) to assess for changes of the flexor tendon pulleys may aid in the detection and monitoring of psoriatic arthritis (PsA), according to a new study presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting. The findings also suggest that 3T MRI assessment may be able to distinguish PsA from rheumatoid arthritis (RA).

To reach these conclusions, Philipp Sewerin, MD, from the University Hospital Düsseldorf in Düsseldorf, Germany, and colleagues performed high-resolution 3T MRI using a dedicated 16-channel hand coil on 17 patients with active PsA, 20 patients with active RA, and 16 healthy control participants.

Images were analyzed by three independent readers for the degree of inflammatory changes, the thickness of flexor tendon pulleys, and comparison with the OMERACT psoriatic arthritis magnetic resonance imaging scoring system (PsAMRIS) and to its subscores (synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, and bone proliferation).

The researchers determined that patients with PsA had thicker flexor tendon pulleys than patients with RA and the controls. Those with PsA also exhibited a higher degree of associated inflammatory changes.

Pulley inflammation was also strongly correlated with total PsAMRIS score and the acute-inflammatory subscores of flexor tenosynovitis, synovitis, and periarticular inflammation.

“The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection and monitoring in PsA, as well as for its distinction from RA and [healthy controls],” the researchers concluded. —Colleen Murphy

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