Achilles tendinitis in psoriasis: Clinical and sonographic findings

Background: Involvement of the Achilles tendon is frequent in psoriatic arthritis, but it is easily missed at clinical examination. Objective. To seek evidence of Achilles tendon abnormalities by means of sonography in psoriatic patients and to correlate sonographic findings with clinical symptoms (tendon and soft-tissue swelling, pain, and difficulty in walking). Methods: Fifty-nine patients with plaque-type psoriasis (Psoriasis Area and Severity index score, 3.7-34-7) and 50 healthy, aged-matched volunteers underwent clinical and sonographic evaluation of Achilles tendons and peritendinous structures. Results: Eighteen (30.5%) of the 59 patients had clinical symptoms of Achilles tendinitis. Thirty-five (59.3%) of the patients had sonographic abnormalities. Of these, 13 patients had clinically symptomatic abnormalities, and 11 had psoriatic arthritis. Degenerative tendinitis was the Most frequent sonographic finding (76.9%) among patients with symptomatic conditions. Five patients with symptoms did not have sonographic alterations. None of the controls had clinical or sonographic changes. Conclusions: In psoriatic patients Achilles tendon abnormalities cannot be excluded even when they are clinically absent.