University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
Arthritis Care Res (Hoboken). 2012 Oct;64(10):1617-21. doi: 10.1002/acr.21733.
Enthesitis is a recognized feature of spondylarthritides (SpA), including psoriatic arthritis (PsA). Previously, ultrasound imaging has highlighted the presence of subclinical enthesitis in established SpA, but there are little data on ultrasound findings in early PsA. The aim of our study was to compare ultrasound and clinical examination (CE) for the detection of entheseal abnormalities in an early PsA cohort.
Forty-two patients with new-onset PsA and 10 control subjects underwent CE of entheses for tenderness and swelling, as well as gray-scale (GS) and power Doppler (PD) ultrasound of a standard set of entheses. Bilateral elbow lateral epicondyles, Achilles tendons, and plantar fascia were assessed by both CE and ultrasound, the latter scored using a semiquantitative (SQ) scale. Inferior patellar tendons were assessed by ultrasound alone. A GS SQ score of >1 and/or a PD score of >0 was used to describe significant ultrasound entheseal abnormality.
A total of 24 (57.1%) of 42 patients in the PsA group and 0 (0%) of 10 controls had clinical evidence of at least 1 tender enthesis. In the PsA group, for sites assessed by both CE and ultrasound, 4% (7 of 177) of nontender entheses had a GS score >1 and/or a PD score >0 compared to 24% (9 of 37) of tender entheses. CE overestimated activity in 28 (13%) of 214 of entheses. All the nontender ultrasound-abnormal entheses were in the lower extremity.
The prevalence of subclinical enthesitis in this early PsA cohort was low. CE may overestimate active enthesitis. The few subclinically inflamed entheses were in the lower extremity, where mechanical stress is likely to be more significant.
附着点炎是脊柱关节炎（SpA）的一个公认特征，包括银屑病关节炎（PsA）。先前，超声成像已经强调了在既定的 SpA 中存在亚临床附着点炎，但关于早期 PsA 的超声发现数据很少。我们研究的目的是比较超声和临床检查（CE）在早期 PsA 队列中检测附着点异常的能力。
42 例新诊断的 PsA 患者和 10 名对照者接受了附着点压痛和肿胀的 CE 检查，以及标准附着点的灰阶（GS）和功率多普勒（PD）超声检查。双侧肘外上髁、跟腱和足底筋膜均通过 CE 和超声进行评估，后者使用半定量（SQ）评分进行评分。仅通过超声评估髌下肌腱。GS SQ 评分>1 和/或 PD 评分>0 用于描述明显的超声附着点异常。
42 例 PsA 患者中有 24 例（57.1%）和 10 例对照者中有 0 例（0%）有至少 1 个压痛附着点的临床证据。在 PsA 组中，对于通过 CE 和超声评估的部位，与压痛附着点相比，4%（177 个中的 7 个）无压痛附着点的 GS 评分>1 和/或 PD 评分>0，而 24%（37 个中的 9 个）压痛附着点的 GS 评分>1 和/或 PD 评分>0。CE 高估了 214 个附着点中的 28 个（13%）的活性。所有无压痛的超声异常附着点均在下肢。
在这个早期 PsA 队列中，亚临床附着点炎的患病率较低。CE 可能高估了活跃的附着点炎。少数亚临床炎症附着点位于下肢，机械应力可能更为显著。
