The Emerging Role of Ultrasound in Psoriatic Arthritis

Screening for PsA in dermatology clinics remains a challenge due to time constraints and limited rheumatology access. Tools such as the PEST questionnaire offer an efficient way to flag patients at risk, but a positive screen does not always indicate PsA. If every positive result leads to a referral, it risks overwhelming an already strained rheumatology system. Emerging data suggest musculoskeletal ultrasound could improve diagnostic specificity when used with screening tools, significantly increasing the accuracy of referrals and ensuring that patients who are truly in need of specialist care are seen more promptly.

Several studies have explored integrating ultrasound into dermatology workflows to refine triage, particularly for patients with joint pain but inconclusive clinical findings. Handheld ultrasound devices allow focused assessments of a few painful joints, and some pilot programs have even proposed dedicated ultrasound triage clinics. These models could help identify active inflammation earlier, streamline care, and avoid unnecessary referrals. Although widespread adoption may be limited by training and equipment access, dermatologists already utilizing ultrasound for other conditions (eg, HS or skin cancer) could be well positioned to expand its use for joint assessment.

Looking ahead, AI-assisted ultrasound technology holds promise to further ease the burden on providers. Preliminary devices can scan a patient’s hands and provide automated readouts indicating potential inflammation. Though early results show limited specificity, continued innovation could lead to practical tools that offer quick, accessible decision support. Dermatologists could be trained to detect basic signs of synovitis with minimal effort, allowing them to integrate imaging into their physical exams, much like using a dermatoscope. This shift toward tech-enabled triage—whether via handheld devices or AI-based systems—may significantly improve early PsA detection while preserving the limited capacity of rheumatology services.