Rheumatology Unit, La Paz University Hospital, Pª de Castellana 261, 28046 Madrid, Spain.
Ann Rheum Dis. 2011 Nov;70(11):2008-10. doi: 10.1136/annrheumdis-2011-200352. Epub 2011 Aug 27.
To evaluate the ability of ultrasound (US) to detect the presence and change of Achilles erosions in spondyloarthritis (SpA).
A blind prospective two-dimensional (2D) and three-dimensional (3D) US study of Achilles enthesis erosions in early SpA was undertaken. US examinations were performed at baseline and at 6 and 12 months of follow-up. Clinical outcomes measures were collected.
Bilateral Achilles entheses of 68 patients (35 women) were investigated. The mean Bath Ankylosing Spondylitis Disease Activity Index and C reactive protein (CRP) levels were 4.58 ± 2.05 and 5.97 ± 9.91 mg/l, respectively. The κ values for intrareader agreement for 2D and 3D images were 0.84 and 0.85 for two readers. 2D US visualised 10 erosions (7.4%) and 3D US visualised 13 erosions (9.6%) in 10 patients (14.7%). At 6 and 12 months of follow-up, 25% and 50% of basal erosions had disappeared, respectively and, of the new erosions that appeared at 6 months, 40% had disappeared 6 months later. A statistically significant association between erosion and CRP levels, entheseal Doppler signals and the number of tender and swollen joints was found.
US examination of Achilles erosions is reliable and sensitive to change. An association was found between Achilles erosions and objective activity-based measurements of SpA outcomes.
评估超声（US）检测脊柱关节炎（SpA）患者跟腱附着点侵蚀的存在和变化的能力。
对早期 SpA 患者的跟腱附着点进行了二维（2D）和三维（3D）US 盲法前瞻性研究。在基线和随访 6 个月和 12 个月时进行 US 检查。收集临床结局测量数据。
共纳入 68 例（35 例女性）双侧跟腱附着点患者。平均 Bath 强直性脊柱炎疾病活动指数和 C 反应蛋白（CRP）水平分别为 4.58±2.05 和 5.97±9.91mg/L。两名观察者的 2D 和 3D 图像的内部读者一致性 κ 值分别为 0.84 和 0.85。2D US 可在 10 例患者（14.7%）的 10 个部位检测到 10 个侵蚀（7.4%），3D US 可在 10 个部位检测到 13 个侵蚀（9.6%）。在随访 6 个月和 12 个月时，分别有 25%和 50%的基础侵蚀消失，而在 6 个月时出现的新侵蚀中有 40%在 6 个月后消失。侵蚀与 CRP 水平、附着点多普勒信号以及压痛和肿胀关节数之间存在统计学显著相关性。
US 检查跟腱侵蚀具有可靠性和变化敏感性。发现跟腱侵蚀与 SpA 结局的客观活动相关测量之间存在关联。
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