Department of Rheumatology, Université de Versailles St-Quentin-en Yvelines-Paris Ile de France-Ouest, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France.
Ann Rheum Dis. 2011 Aug;70(8):1433-40. doi: 10.1136/ard.2010.138701. Epub 2011 May 17.
Early diagnosis of spondyloarthritis (SpA) is sometimes difficult owing to the lack of reliable diagnostic criteria. The objective of this study was to determine the diagnostic accuracy of detecting enthesitis by power Doppler ultrasonography (PDUS) in patients with suspected SpA.
A prospective single-centre cohort study was performed in patients with symptoms suggestive of SpA (inflammatory back pain, arthritis, enthesitis or dactylitis, HLAB27+ uveitis) who underwent clinical examination, pelvic x-ray, MRI of lumbar spine/sacroiliac joints, HLA-B typing and other tests judged useful for diagnosis. Blinded PDUS examination of seven sites of enthesitis was performed at baseline. The gold standard was the diagnosis made by the referring rheumatologist according to the development of symptoms and findings, blinded to PDUS results, during routine follow-up for up to 2 years.
Between November 2002 and October 2004, 118 patients were included in the study. After 2 years a definite diagnosis was retained for 99 patients (51 SpA and 48 non-SpA). PDUS detection of at least one vascularised enthesis provided good predictive value for diagnosing SpA (sensitivity 76.5%; specificity 81.3%; positive likelihood ratio 4.1; OR 14.1; p<0.0001). Vascularised enthesitis detected by PDUS and Amor's criteria were the only independent contributors to a diagnosis of SpA in multivariate logistic regression (c-index=0.87). Alternatively, CART analysis resulted in a highly sensitive and specific diagnostic tree by combining PDUS with Amor's criteria.
PDUS appears to be a valuable first-line diagnostic tool to confirm a diagnosis of SpA.
由于缺乏可靠的诊断标准，脊柱关节炎（SpA）的早期诊断有时较为困难。本研究旨在确定超声（PDUS）检测肌腱附着点炎对疑似 SpA 患者的诊断准确性。
本前瞻性单中心队列研究纳入了有 SpA 症状（炎性腰痛、关节炎、肌腱附着点炎或指（趾）炎、HLAB27+葡萄膜炎）的患者，对这些患者进行了临床检查、骨盆 X 线、腰椎/骶髂关节 MRI、HLA-B 型和其他认为有助于诊断的检查。在基线时对 7 个肌腱附着点进行 PDUS 检查。金标准是根据症状和检查结果，由转诊的风湿病医生在常规随访 2 年内做出的诊断，结果对 PDUS 检查结果设盲。
2002 年 11 月至 2004 年 10 月，共有 118 例患者入组。2 年后，99 例患者保留了明确诊断（51 例 SpA 和 48 例非 SpA）。至少有一个血管化的肌腱附着点被 PDUS 检测到，对诊断 SpA 具有良好的预测价值（敏感性 76.5%，特异性 81.3%，阳性似然比 4.1，优势比 14.1，p<0.0001）。PDUS 检测到的血管化肌腱附着点炎和 Amor 标准是多变量逻辑回归中唯一能独立诊断 SpA 的因素（C 指数=0.87）。或者，通过结合 PDUS 和 Amor 标准，CART 分析得出了一个高度敏感和特异的诊断树。
PDUS 似乎是一种有价值的一线诊断工具，可用于确认 SpA 的诊断。
