I am seeing a new rheumatologist for my psoriatic arthritis. She seems bent on having every imaging study done possible — X-rays, MRIs, ultrasound. My old rheumatologist didn’t do all this business. Do I really need all these studies?

Psoriatic arthritis (PsA) can be a very aggressive disease. Based on the evidence we have so far, it is believed that early recognition and treatment of this problem yields better results.

There is often a wide range of signs and symptoms involving many different body parts. Physicians must use several diagnostic tools such as X-rays, ultrasonography, and MRIs to catch them all.

Each one of these tests provides a little different information. For example, X-rays show early signs of bone erosion but do not reveal anything about the condition of tendons, ligaments, or other soft tissues often affected by psoriatic arthritis.

Ultrasonography, the use of sound waves to create a picture of what’s going on inside, provides a better look at the whole package: bones, joints, and soft tissues. This diagnostic test is also noninvasive and does not expose you to any radiation. Ultrasound also has the ability to show small changes in the nails and early signs of inflammation in tendons and small joints.

MRIs can show bone marrow edema, tenosynovitis, and early joint erosion. Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. Changes in the small joints of the hands and feet don’t show up well on MRIs like they do with ultrasonography.

One advantage MRIs do have over ultrasonography is the availability of whole body MRI. By scanning the entire body, it is possible to identify areas of inflammation undetected by clinical exam. And whole-body ultrasonography just isn’t reasonable.

Knowing that the correct management of this condition depends on early detection of bone, joint, and soft tissue pathology helps us understand the need for improved diagnostic and treatment approaches.

The potential for severe progression of disease may be halted (or at least slowed) with a management approach that includes (repeated or serial) diagnostic imaging throughout the course of treatment.

It sounds like your rheumatologist is right on target with the evidence we have today about the best way to care for patients with psoriatic arthritis.