Should we look for an infraclinical synovitis?

Psoriatic rheumatism (RP) affects 30 % of patients with skin psoriasis. In addition, Typically, in adults, skin psoriasis precedes the PR but in 85 % of cases the diagnosis of the two locations is simultaneous. Consequently, On the other hand, in children, the PR manifests itself before skin psoriasis in half of the cases. In addition,

Even if the characteristics of the Cutaneous RP-P-Psooriasis association are well established. However, the transition between both involvement deserves to be more explored. For example, Thus the synovitis. In addition, which is not in itself an RP criterion, is still emblematic of this rheumatism and it is believed that it precedes the appearance of the PR. Identification in imaging (ultrasound. MRI) of a synovitis in patients with psoriasis without musculoskeletal signs could represent an index of the evolution of a skin psoriasis to an RP.

A team from should we look infraclinical synovitis? the University of Toronto produced a systematic review of the literature with meta-analysis to assess the. prevalence of synovitis in patients with skin psoriasis without musculoskeletal manifestations.

A possible marker of evolution towards psoriatic rheumatism

The literature review found 12 transversal studies. control cases bringing together:

• 1,593 patients (982 men and 611 women) with skin psoriasis, aged 46.7 years [7,5],
• 327 patients (210 men and 117 women) with RP (average age 50.2 years [7,1],
• 686 healthy subjects (controls) aged on average 45.7 years [6,9].

In the Psoriasis group the disease had been installed for 14.8 years on average [4,5] and the pasi (Psoriasis Area Severity Index) was on average 8.2 [4,4] ; In the group with RP, the disease had lasted an average of 9.8 years [2,6] And the average pasi was 7.6 [5,7].

The probability of detecting an infraclinical synovitis in patients with psoriasis (compared to checks) appeared approximately 2.5 times higher ((RR RR should we look infraclinical synovitis? risk: 2.55; 95 % confidence interval, 95 % 1.18-5.52 CI). The presence of a synovitis was twice as frequent in the RP group but without statistical significance.

These observations illustrate the increased probability of detecting in imaging (more with MRI than in ultrasound) synovitis in patients with psoriasis without musculoskeletal symptoms. compared to control subjects. This “infraclinical” synovitis could be an early indicator of the inflammatory changes preceding the occurrence of an PR. This implies the possibility of identifying. thanks to imaging, among patients with psoriasis those who are at risk of developing an PR and thus considering early management. Longitudinal studies are however necessary to determine the predictive value of infraclinical synovitis. assess the interest of interventions intended to reduce the risk of occurrence of an PR.