Comparison of clinical and sonographical findings of Achilles tendon involvement in newly diagnosed and established cases of psoriasis

Abstract

Objective To compare the clinical and sonographical findings of Achilles tendon involvement in newly diagnosed (disease duration <6 months) and established psoriatic patients (disease duration >5years). Patients and methods This cross-sectional, comparative study was carried out in Departments of Dermatology and Radiology, Military Hospital, Rawalpindi, over a period of six months. 70 patients of psoriasis were divided into two groups comprising 35 patients in each. Group I patients were newly diagnosed cases while group II included the established psoriatic patients. All patients with clinical and histological evidence of psoriasis were included. Patients with history of osteoarthritis, rheumatoid arthritis or foot trauma were excluded. Detailed history and complete clinical examination was carried out as per pro forma. The condition was considered symptomatic when there was tendon swelling, pain, tenderness or functional impairment. Ultrasound of Achilles tendon was done, keeping patient in prone position by using Pro Sound SSD 5500 Toshiba ultrasonographic machine with high frequency probe (7.5MHz) to assess findings of Achilles tendon in psoriatic patients. Fibrillar tendon structures, tendon thickness, peritenon, and bursae were evaluated. Results On clinical assessment 1 (2.8%) patient in group I and 5 (14.3%) patients in group II had Achilles tendon involvement. On ultrasonographic assessment, 3 (8.5%) patients in group I and 15 (42.8%) patients in group II showed involvement of Achilles tendon (p <0.05). Conclusion Achilles tendon involvement occurs in significant number of patients with long standing psoriasis as compared to newly diagnosed cases. It also revealed that enthesitis progresses with the duration of disease.