Musculoskeletal US: Taking the Management of Psoriatic Arthritis to a New Horizon

Understanding the disease pathogenesis and tissues structure changes have a positive impact on its management. In psoriatic patients suffering from arthritis, there is a variable spectrum of pathologic changes that include joint and tendon inflammation, new bone formation as well as severe osteolysis. This led to the proposition of the term “psoriatic disease” to encompass the involvement at different tissue and organ levels. The continuous technological advances in the field of musculoskeletal ultrasound allowed the detailed study of morpho-structural changes of the joints, entheses as well as skin and nails. Power Doppler Ultrasonography allowed the sensitive detection of blood flow even in small vessels of superficial tissues which facilitated the assessment of the inflammatory process activity and response to therapy. The ease of access, ability to scan repeatedly, as well as utility of ultrasound in the assessment of different musculoskeletal components offer major advantages over MRI and nuclear medicine in standard clinical practice. This article will review how US imaging has the potential to transform our understanding of psoriasis, and the potential role of musculoskeletal US, as a sensitive imaging modality, to assess the inflammatory process, disease activity as well as outcomes of therapy in patients with psoriatic arthritis.