Should Patients With Skin Psoriasis Receive Routine MRI Screening?

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Routine screening with magnetic resonance imaging (MRI) of patients with psoriasis limited to the skin may not be necessary, according to the findings of a recent study. The study showed that patients with psoriasis and no clinical evidence of peripheral or axial inflammation had similar signs of subclinical inflammation and inflammatory lesions on the spine and sacroiliac joints (SIJ) as healthy controls.

The study included 20 participants with psoriasis limited to the skin (median disease duration 23 years; median age 48.5 years) and 22 healthy controls. Participants underwent standard dermatologic and rheumatologic clinical examination and unenhanced 1.5T magnetic resonance imaging (MRI) of the SIJ and the entire spine. The presence or absence of SIJ inflammation was assessed by 2 blinded readers simultaneously on T1-weighted and Short TI Inversion Recovery MRI sequences. In addition, bone marrow edema, fat metaplasia, erosion, ankylosis of the SIJ, and vertebral corner inflammatory and fat lesions were documented.  
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Overall, 25% of participants with psoriasis and 9.1% of healthy controls were found to have SIJ inflammation. The prevalence of bone marrow edema and structural lesions on the SIJ and spine MRI were comparable among participants with psoriasis and healthy controls.

“In this controlled study, patients with skin psoriasis, but no clinical arthritis or spondylitis showed limited evidence of concomitant subclinical axial involvement by SIJ and spine MRI,” the researchers concluded. “These findings do not support routine screening for subclinical axial inflammation in patients with longstanding skin psoriasis.”

Reference

Bratu VA, Häusermann P, Walker UA, et al. Do patients with skin psoriasis show subclinical axial inflammation on MRI of the sacroiliac joints and entire spine? [published online September 22, 2018]. Arthritis Care Res. https://doi.org/10.1002/acr.23767