Ultrasound Detects Subclinical Enthesopathy in 85.7 Percent of Psoriasis Patients, Suggests Study

Psoriasis is a chronic, immune-mediated inflammatory disease affecting 2% to 3% of the global population, and while previous research has established that enthesitis is a hallmark of psoriatic arthritis (PsA), a clinical gap remains in identifying this inflammation before joint symptoms appear. To bridge this gap, Dr. Kallolinee Samal and co-workers from the Department of Dermatology, Institute of Medical Sciences (IMS), and SUM Hospital Campus II, Odisha, India, designed this study to evaluate subclinical enthesitis in psoriasis patients using high-resolution ultrasonography (USG) and the standardized Outcome Measures in Rheumatology (OMERACT) scoring system.

Therefore, the prospective, observational study at an East Indian tertiary hospital evaluated 91 chronic plaque psoriasis patients without clinical arthritis from January 2024 to January 2025. Excluding individuals with existing joint disease or systemic comorbidities, researchers used high-resolution ultrasonography to assess subclinical enthesitis across 12 sites, correlating the severity and duration of skin disease with entheseal changes.

Key Clinical Findings of the Study Includes:

• High Subclinical Prevalence: The study identified silent enthesitis in 85.7% of the psoriasis patients, spanning 929 ultrasonographically abnormal entheseal sites.

• Vulnerability of Achilles Tendon: The study determined the Achilles tendon as the most frequently involved site with 263 positive findings (comprising 132 structural and 131 inflammatory abnormalities), compared to the triceps tendon with 226 findings and the proximal patellar ligament with only 85 findings.

• Inflammatory and Structural Breakdown: The study recorded structural lesions in 75% of participants, dominated by 351 calcifications, whereas inflammatory abnormalities were observed in 79.1% of patients, consisting primarily of tendon thickening at 480 sites.

• Correlation with Skin Severity: The study demonstrated a statistically significant association (P < 0.05) between higher Psoriasis Area and Severity Index (PASI) scores and increased entheseal damage.

• Independence from Disease Duration: The study revealed that subclinical enthesitis occurs independently of how long a patient has had psoriasis, showing no statistically significant correlation with disease duration.

The results suggest that subclinical enthesopathy is extraordinarily common, affecting 85.7% of psoriasis patients without clinical arthritis, which emphasizes the diagnostic power of high-resolution ultrasonography in identifying early joint disease.

In light of these findings, dermatologists should consider integrating routine musculoskeletal ultrasound assessments into the standard management of patients with severe psoriasis to enable early clinical intervention and potentially prevent the progression to debilitating joint disease.

While the single-center study is limited by its cross-sectional design, the lack of matched healthy controls, and the omission of axial skeletal scans, these constraints highlight the need for future longitudinal, multicenter trials that include axial entheseal sites to provide an even more comprehensive understanding of early psoriatic disease.

Reference

Samal K, Kar B, Khuntia M, Biswal A, Panda AK, Dixit N. Enthesis assessment in patients with chronic plaque psoriasis by high-resolution ultrasonography: A hospital-based cross-sectional study. Indian Journal of Dermatology 2026; XX(XX): 1-5.