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. 2025 May 30:16:1562996.
doi: 10.3389/fimmu.2025.1562996. eCollection 2025.

The concordance of swelling/tenderness with ultrasound-detected inflammatory lesions in patients with psoriatic arthritis

Xiaoying Sun  1 , Yan Geng  1 , Zhibo Song  1 , Xuerong Deng  1 , Xinyi Hu  1 , Yu Wang  1 , Xiaohui Zhang  1 , Juan Zhao  1 , Guangtao Li  1 , Lanlan Ji  1 , Wenhui Xie  1 , Hong Huang  1 , Zhuoli Zhang  1
Affiliations

The concordance of swelling/tenderness with ultrasound-detected inflammatory lesions in patients with psoriatic arthritis

Xiaoying Sun et al. Front Immunol. .

Abstract

Background: Psoriatic arthritis (PsA) is a complex and varied inflammatory condition that can cause arthritis, enthesitis, dactylitis, and spondylitis. In recent years, ultrasound (US) imaging has emerged as a valuable adjunct to physical examination (PE) in the assessment of PsA. This study aims to assess the concordance between clinical manifestations of swelling/tenderness and US-detected inflammatory lesions in the wrists and hands of patients with PsA.

Methods: The study utilized the PKUPsA cohort and included both clinical and US evaluations of 30 joints per PsA patient, encompassing bilateral wrists, proximal interphalangeal (PIP), metacarpophalangeal (MCP), and distal interphalangeal (DIP) joints. Clinical assessments included the detection of tenderness or swelling, while US evaluations identified synovitis, tenosynovitis/paratenonitis, enthesitis, and soft tissue inflammation. Cohen's kappa (κ) statistic was employed to measure the concordance between clinical and sonographic findings.

Results: A total of 188 patients with PsA were included in the study. US-detected inflammatory lesions were more common in swollen joints than tender joints (50.6% vs. 40.3%, p<0.01). The overall concordance between clinical findings and US-detected inflammatory lesions was found to be moderate (κ=0.448, p<0.01). Joint swelling showed a higher level of concordance with US-detected inflammation (κ=0.497, p<0.01) than tenderness (κ=0.406, p<0.01). In the MCPs and wrists, synovitis exhibited a higher concordance with PE than tenosynovitis/paratenonitis. In contrast, in most PIP joints, US-detected tenosynovitis/paratenonitis aligned more closely with PE than synovitis. In DIP joints, enthesitis showed a greater concordance with PE than both synovitis and tenosynovitis/paratenonitis.

Conclusions: Ultrasound-detected inflammatory lesions in PsA patients showed a moderate level of concordance with PE in PsA patients, but significant discrepancies were observed across different joints and lesion types. These findings highlight the importance of incorporating US into the routine management for a more comprehensive understanding of PsA.

Keywords: arthritis; inflammation; physical examination; psoriatic; ultrasonography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Ultrasound imaging of diverse inflammatory lesions in the hand. (A) Synovitis (white arrow). (B) Tenosynovitis (green arrow). (C) Paratenonitis (green arrowhead). (D) Enthesitis (white arrowhead). (E) Soft tissue inflammation (yellow arrowhead). DP, distal phalanx; IP, intermediate phalanx; M, metacarpal bone; PP, proximal phalanx.
Figure 2
Figure 2
Frequencies of ultrasound-detected inflammatory lesions in tender or swollen joints in wrist and finger joints. DIP, distal interphalangeal; MCP, metacarpophalangeal; PIP, proximal interphalangeal. *P-value<0.05.
Figure 3
Figure 3
The concordance (κ coefficient) between joint tenderness/swelling and ultrasound-detected inflammatory lesions. DIP, distal interphalangeal; MCP, metacarpophalangeal; PIP, proximal interphalangeal. Ultrasound-detected inflammatory lesions: GS≥2 or PD≥1 for synovitis, tenosynovitis/paratenonitis, enthesitis, or soft tissue inflammation.
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