Ultrasound of the small joints of the hand in the polyarticular psoriaticarthritis population

Early polyarticular psoriaticarthritis (EPsA) can be difficult in patients with symmetrical polyarthritis of the MCP and PIP joints of the hands because standard radiographs are often unhelpful in early phases and no specific biomarkers are currently available, hence the need of new diagnostic approaches. The study of Zabotti et al. (2018) highlights the role of imaging techniques, i.e., proximal nailfold dermoscopy and ultrasound (US) of small joints of the hand, as well as integrated rheumatological-dermatological clinical assessment in facilitating the correct diagnosis of such types of arthritis. The view that a strict collaboration between the rheumatologist and the dermatologist is a relevant step toward diagnosis, with potential reduction of misclassifications, is being reinforced. This finding could have important implications for management and outcome because an early and correct diagnosis is crucial for choosing the best treatment and getting the greater likelihood to achieve remission, especially when using therapeutic options which are effective in polyarticular psoriatic arthritis but not in rheumatoid arthritis (RA).