POS0143 POST-STRESS ULTRASOUND ASSESSMENT OF THE ACHILLES TENDON IS USEFUL TO DIFFERENCIATE PSORIATIC ARTHRITIS FROM THE PHYSIOLOGICAL ADAPTATION TO EXERCISE
Background:Achilles enthesitis is the most accessible psoriatic arthritis hallmark to assess through ultrasound scan. Recently it has been demonstrated that continuous mechanical stress such as experimented by runners can drive to the development of physiological morphological changes that resembles those observed in psoriatic arthritis. In a subject with the suspicious diagnostic of psoriatic arthritis who practice any sports associated to continuous impact over the heels, the challenge to determine in what extent the morphological changes are linked to the exercise or to the disease, is remarkable.Objectives:To determine morphological differences between patients with psoriatic arthritis, trained runners and sedentary volunteers through ultrasound scan of the Achilles tendon.Methods:An ultrasound scan of the Achilles tendon was performed to the following subjects: Patients with diagnosis of psoriatic arthritis with a DAPSA score of low activity in at least six months and with history of heel pain in the past, volunteers runners with not less of 3-year sport activity at least three times a week and sedentary volunteers. In the group of patients, ultrasound scan was performed over the feet with history of heel pain. In the case of volunteers, the ultrasound scan was performed in the dominant feet. The selection of volunteers was not randomly-based in order to match their age and sex to the patients as much as possible. Besides demographic features, a comparison between tendon thickness at the level of the calcaneus bone border and the height of the retrocalcaneus bursae in the longitudinal axis were performed through ANOVA test. Power Doppler signal was scaned in all subjects before and after a controlled mechanical stress of the Achilles tendon by climbing stairs (100 steps, two times).Results:Female/male distribution of the group of patients, runners and sedentary people were: 12/10, 18/18 and 20/18, respectively. Achilles tendon mean thickness ± standard deviation was 6.61 ± 1.05, 5.91 ± 1.44 and 4.61 ± 2.1mm, respectively (P=0.01). Retrocalcaneus bursae height was 3.42 ± 0.21, 3.22 ± 0.27 and 2.21 ± 0.31 (P=0.01). Basal PD signal was present into the enthesis of 2/22, 1/36 and 0/38, respectively (P not significant). After exercise, PD signal was present in 8/22, 5/36 and 0/38, respectively (P<0.001).Conclusion:Power Doppler signal after exercise was identified as the most relevant ultrasound hallmark to distinguish a patient with psoriatic arthritis from a trained runner, even when psoriatic arthritis were considered as low activity. Post exercise ultrasound scan should be considered as a diagnosis tool in sportsmen with suspicious of psoriatic arthritis, until further studies confirm our findings.Disclosure of Interests:None declared