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Role of Radiology in Diagnosing

Psoriatic Arthritis
Medically reviewed by Stella Bard, MD — By Daniel Yetman on February
6, 2024

X-rays CT MRI Ultrasound Vs. other arthritis types Other tests

Next steps Takeaway

Radiology, such as X-ray imaging, can help doctors

detect specific structural changes to your joints that may
indicate psoriatic arthritis (PsA). They may also use other
imaging, such as MRI, to detect inflammation.

Imaging, including radiology, plays an important role in allowing doctors

to diagnose PsA and distinguish it from other joint conditions. It can also
help doctors see the extent of your joint damage and track how the
disease progresses.

Doctors often use X-rays as the first type of imaging to diagnose PsA,
but you may also receive:

ultrasound

MRI

CT scans

This article examines the role that imaging plays in diagnosing and
tracking PsA.

Peripheral vs. axial PsA

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Doctors often classify PsA as peripheral or axial depending on
which joints the condition affects.
 Peripheral disease affects the joints in your extremities, like your
hands or feet. Axial disease affects your spinal cord. Some
people have both types.

Peripheral PsA is more common, but 25–70% of people also

have spinal cord involvement.

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Psoriatic arthritis on X-rays

Hand X-rays can show signs of psoriatic arthritis, such as bone erosion and the
“pencil-in-cupâ€A deformity. 
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Copyright © 2015 The Korean Dermatological Association and The Korean Society
for Investigative Dermatology CC BY-NC 3.0
X-rays are the most performed imaging technique for PsA. They create
an image of your joints by passing a small amount of radiation through
your body.

Around one-quarter of people with early PsA have joint damage that
shows up on X-rays, and about half of people have visible damage within
2 years, according to a notable 2003 study.

X-rays are advantageous because they’re:

fast

relatively inexpensive

reliable

widely available

Doctors can use X-rays to identify structural damage to your joints, such
as:

joint destruction

bone erosion

new bone formation

joint space narrowing

pencil-in-cup deformity, a characteristic feature of PsA that

develops in the small joints in your hands

X-rays require exposure to a small amount of radiation. For this reason,

doctors may prefer MRI for spinal cord evaluation in children and young
adults.

Axial PsA

Changes to your spine visible on an X-ray include:

new bone formation

changes toA multiple 

D V E R T I S E M levels
EN T of your spine

joint changes on one side, which highly suggests PsA

Psoriatic arthritis on CT scans

CT scans can help doctors detect signs of psoriatic arthritis like bone erosion and
structural changes, especially in areas like the shoulder, spine, or pelvis.
Crespo-Rodríguez, A.M., Sanz Sanz, J., Freites, D. et al. Role of diagnostic imaging in
psoriatic arthritis: how, when, and why. Insights Imaging 12. CC BY 4.0

A CT scan is a series of X-rays that produces a 3D image of your joint.

CT scans are great for seeing:

bone erosions

new bone formation

joint space changes

The role of CT scans in diagnosing PsA is usually limited to people who

can’t receive MRI. This is because CT scans can’t detect active
inflammation and require exposure to higher amounts of radiation than
plain X-rays.

CT scans might be helpful in complex and difficult joints such as the:

shoulder girdle

spine
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pelvis
 sacroiliac (SI) joint
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Psoriatic arthritis on MRI scans

A knee MRI shows changes due to psoriatic arthritis, such as the buildup of synovial
fluid around the joint.
Copyright © 2020 Mathew and Østergaard. CC BY

MRI uses powerful magnets to create an image of the inside of your

body. MRI is highly sensitive for detecting inflammation in and around
your joints and in your soft tissues.

MRI is more sensitive than X-ray for detecting early joint inflammation 
AD VER T I SEM EN T
and damage.
Doctors often recommend MRI for sacroiliitis if X-rays are inconclusive.
Sacroiliitis is a potential feature of PsA when the SI joint becomes
inflamed.

Psoriatic arthritis on ultrasound scans

Ultrasound images can reveal areas of bone damage as well as inflammation due to
psoriatic arthritis.
Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic
Arthritis, the Sonographic Perspective. Curr Rheumatol Rep. 202 CC BY 4.0 DEED

Ultrasound uses high frequency sound waves to create an image of your

tissues. Ultrasound is:

quick

cheap

widely available

Ultrasound also allows doctors to scan multiple sites in one session. Like
MRI, ultrasound is more sensitive than plain X-ray for detecting early
joint inflammation. Ultrasound is a useful technique for evaluating
inflammatory changes in soft tissues such as:

joint lining 

AD VER T I SEM EN T

tendons
 bursas

entheses, where tendons or ligaments connect to bone

The main drawbacks of ultrasound are that it can’t penetrate bone

and it doesn’t help doctors identify changes to your spinal cord well.

When might a doctor recommend radiologic tests for

psoriatic arthritis?

Imaging plays a vital role in the early diagnosis of PsA. Your

doctor may send you for imaging if you have characteristic
features such as:

joint pain and swelling

nail and skin changes
a personal or family history of psoriasis
uveitis, inflammation of the middle layer of your eye

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Can doctors distinguish psoriatic arthritis from other

arthritis types using radiology?
AD VER T I SEM EN T
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Doctors can use imaging to look for characteristic signs of PsA to help
distinguish it from other types of inflammatory arthritis.

For example, seeing the “ray pattern,” when all three joints in one
finger or toe are inflamed, can help doctors differentiate PsA from
rheumatoid arthritis.

Another characteristic sign of PsA is the pencil-in-cup deformity. This

happens when a bone in your finger is narrow and the bone below it is
wide.

What other tests do doctors use to confirm psoriatic

arthritis?
Doctors can usually diagnose PsA if you have classic symptoms of
psoriasis and inflammatory arthritis in a typical PsA pattern.

Other tests you may receive to support your diagnosis include:

a physical exam

gene tests for HLA-B27

skin biopsy

laboratory tests to examine erythrocyte sedimentation rate or C-

reaction protein levels

What can I expect after imaging tests for psoriatic

arthritis?
After imaging, your doctor may recommend medications to help manage
your symptoms, such as:

nonsteroidal anti-inflammatory drugs (NSAIDs)

disease-modifying antirheumatic drugs (DMARDs)

a class of biologics called tumor necrosis factor (TNF) inhibitors

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They may also recommend making an effort to incorporate certain

lifestyle changes, such as:
 quitting smoking, if you smoke

maintaining a moderate weight

exercising regularly

Takeaway
X-rays are the most common type of imaging doctors use to diagnose
and monitor PsA. Doctors also use other types of imaging such as CT
scans, ultrasound, or MRI.

Your doctor might recommend further imaging if initial X-rays are

inconclusive. Other scans, such as MRI or ultrasound, can better show
inflammation in your soft tissues.

Your doctor may recommend MRI instead of X-rays as your initial scan if
they want to limit your radiation exposure.

Last medically reviewed on February 6, 2024

How we reviewed this article:

SOURCES HISTORY

Our experts continually monitor the health and wellness space, and we
update our articles when new information becomes available.
Current Version

Feb 6, 2024

Written By
Daniel Yetman

Edited By
A. L. Heywood

Medically Reviewed By
Stella Bard, MD
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Copy Edited By
AD VER T I SEM EN T

Sofia Santamarina
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