Enthesitis and synovitis on magnetic resonance imaging are frequently found in psoriatic patients without arthritic symptoms: Clinical considerations of this finding

Patients with skin psoriasis often perceive complaints such as fatigue and vague aches and pains in the joints, often diagnosed as fibromyalgia or psychogenic. We showed in psoriasis patients, without complaints or signs of arthritis on knee magnetic resonance imaging, evidence of subclinical inflammation at the attachments of tendons (enthesitis) and of the joints. These findings indicate that enthesitis may be an early sign (perhaps the earliest) of subclinical psoriatic arthritis and may, for example, explain a lot of problems these psoriatic patients perceive. We discussed our findings in the light of recent literature regarding enthesitis as an early sign in spondyloarthropathies like psoriatic arthritis and also in early osteoarthritis and the possible clinical implications. Our findings may change the paradigm regarding arthritis complicating this skin disease and lead to a different treatment approach of these patients.