Shear Wave Elastography Assessment of Achilles Tendon Stiffness in Asymptomatic Patients with Psoriatic Arthritis

TL;DR

This study used a special ultrasound technique to find that tendons in people with psoriatic arthritis are stiffer, even when they don't have symptoms.

Contribution

The study introduces shear wave elastography as a potential tool for detecting tendon stiffness in asymptomatic psoriatic arthritis patients.

Findings

Achilles tendon stiffness was significantly higher in psoriatic arthritis patients compared to healthy controls.

Shear wave velocity and Young’s modulus values were elevated in psoriatic arthritis patients.

Shear wave elastography showed good ability to distinguish psoriatic arthritis patients from controls.

Abstract

Objectives: We aimed to evaluate Achilles tendon stiffness characteristics in asymptomatic patients with psoriatic arthritis (PsA) using shear wave elastography (SWE). Methods: In this prospective case–control study, 34 asymptomatic PsA patients and 34 age- and sex-matched healthy controls underwent bilateral Achilles tendon evaluation with grayscale ultrasonography and SWE. Tendon thickness was measured 3 cm proximal to the calcaneal insertion. Shear-wave velocity (m/s) and Young’s modulus (kPa) were obtained under standardized acquisition conditions, including five-star motion stability and ≥90% reliability. Results: Achilles tendon morphology and thickness did not differ between PsA patients and controls (p > 0.05). In contrast, SWE demonstrated higher tendon stiffness in the PsA group. Mean shear-wave velocity was significantly greater in PsA patients for both the left (4.89 ± 2.52 m/s vs. 3.23 ± 0.41 m/s; p < 0.001) and right tendons (4.88 ± 1.94 m/s vs. 3.12 ± 0.30 m/s; p < 0.001), with corresponding increases in Young’s modulus (all p < 0.001). SWE demonstrated good group discrimination, with shear-wave velocity achieving AUC values of up to 0.90 in differentiating PsA patients from healthy controls. Conclusions: SWE may reflect biomechanical tendon alterations in PsA, even in the absence of clinical symptoms, and may serve as a complementary imaging tool in the assessment of tendon involvement.

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