Achilles arthropathy may be present in patients with psoriatic arthritis even without symptoms. Therefore, ultrasonography of the Achilles tendon should be considered soon after diagnosis of psoriasis, according to findings published in the British Journal of Dermatology.

The enthesis, or the point where a tendon attaches to the bone, represents the initial site of articular inflammation and the enthesis of the Achilles tendon is the first to be affected.

To determine if ultrasonography aided early diagnosis, Giuseppe Pistone, MD, of the University of Palermo in Italy, and colleagues evaluated 59 patients (n=16 women; 43 men) with chronic plaque psoriasis and compared them with 59 patients with other dermatologic conditions. The investigators also sought to identify significant alterations of enthesitis beyond increased thickness of the Achilles tendon.

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All patients included in the study underwent echographic evaluation of the Achilles heel. Psoriasis severity was evaluated by the Psoriasis Area Severity Index and the enthesitis by the Glasgow Ultrasound Enthesitis Scoring System.

Enthesitis was more severe among patients with psoriasis than patients with other dermatologic conditions, found the researchers. Tendon thickness over 5.29 mm and irregular tendon structure was found in 13 patients with psoriasis, and other tendon abnormalities were found in 12 patients; bursitis was discovered in seven patients.

The authors concluded that Achilles tendon ultrasonography may detect early psoriatic arthritis in patients with cutaneous psoriasis.

“Our data confirm that ultrasonography is a sensitive technique which reveals enthesitis more frequently than clinical examination in patients affected by psoriasis,” concluded the study authors.

“We suggest the use of ultrasonography of the Achilles tendon in early diagnosis of psoriatic arthropathy with the objective of preventing progression of the pathology.”


  1. Pistone G. Br J Dermatol. 2014;doi: 10.1111/bjd.13135