Targeting Structural Damage in Psoriatic Arthritis: The Impact of Early Recognition and Timely Intervention - Episode 6
Assessing for Structural Damage in Clinical Practice
Experts discuss the complementary roles of imaging modalities in psoriatic arthritis assessment, noting the continued use of x-rays for tracking structural damage, the added value of ultrasound and MRI in detecting subclinical inflammation, and how advanced imaging supports proactive disease management despite practical limitations in routine care.
In clinical practice, the assessment of psoriatic arthritis often involves a combination of imaging tools to monitor both structural damage and subclinical disease activity. Although ultrasound is a valuable modality for detecting early inflammation or equivocal joint findings, baseline x-rays of the hands, feet, and any affected joints are still widely used as a standard approach. These help establish a reference point for structural changes and are repeated periodically to track progression. MRI can also be used when accessible, offering additional sensitivity for soft tissue and joint changes, although insurance hurdles can make it less practical in routine care.
In the context of clinical trials, assessments are more rigorous and standardized. A commonly used scoring system for psoriatic arthritis is the modified Sharp/van der Heijde score, which quantifies joint space narrowing and erosions in the hands, wrists, and feet. This scoring method enables the precise tracking of structural damage over time, with a maximum possible score of 528. Although effective in a research setting, it is not practical for daily clinical use due to its complexity and the time required for evaluation. Instead, practicing rheumatologists rely on radiology reports to identify signs of new or worsening erosions that signal the need for therapeutic adjustment.
Advanced imaging modalities such as ultrasound and MRI offer additional value beyond structural assessment. Increased Doppler signal on ultrasound, for instance, can be an early indicator of potential joint damage and a predictor of future disease flare, even in patients who appear to be in remission. These tools support proactive management strategies, allowing clinicians to intervene before irreversible damage occurs. Although these tools are not universally available or feasible in every clinical setting, their integration into care—especially in patients with ambiguous symptoms—can significantly improve disease monitoring and outcomes.
