Kristensen Salome, Christensen Jeppe Hagstrup, Schmidt Erik Berg, Olesen Jens Lykkegaard, Johansen Martin Berg, Arvesen Kristian Bakke, Schlemmer Annette
Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
Muscles Ligaments Tendons J. 2016 Sep 17;6(2):241-247. doi: 10.11138/mltj/2016.6.2.241. eCollection 2016 Apr-Jun.
Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability.
To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clinical examination for the detection of entheseal abnormalities.
20 rheumatologists performed repeated assessment of enthesitis in patients with established psoriatic arthritis before and after a 2-hour training session in standardised enthesitis count according to Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Moreover, 20 patients underwent clinical and ultrasonographic examination of entheses to evaluate consensus-based elementary lesions of enthesitis.
Training significantly increased Intra-class Correlation Coefficient for LEI from 0.18 to 0.82 and for SPARCC from 0.38 to 0.67. Ultrasound examination showed high associations between hypoechogenicity and increased thickness of the entheses and clinical examination. There was no correlation between erosions and enthesophytes found by ultrasound and clinical assessments.
Training in standardised enthesitis scoring systems significantly improved clinical assessments of enthesitis and should be performed before use in daily clinical practice. Ultrasound revealed more advanced stages of enthesitis, such as enthesophytes and erosions, which were not detected with clinical examination.
附着点炎是银屑病关节炎的主要特征。然而，已知附着点炎的临床评估缺乏准确性，且观察者间可靠性较差。
确定培训对附着点炎临床评估的影响，并比较超声检查与临床检查在检测附着点异常方面的差异。
20名风湿病学家在根据利兹附着点炎指数（LEI）和加拿大脊柱关节炎研究联盟附着点炎指数（SPARCC）进行标准化附着点炎计数的2小时培训课程前后，对确诊的银屑病关节炎患者的附着点炎进行重复评估。此外，20名患者接受了附着点的临床和超声检查，以评估基于共识的附着点炎基本病变。
培训显著提高了LEI的组内相关系数，从0.18提高到0.82，SPARCC的组内相关系数从0.38提高到0.67。超声检查显示，低回声和附着点厚度增加与临床检查之间存在高度相关性。超声和临床评估发现的侵蚀与附着骨赘之间没有相关性。
标准化附着点炎评分系统的培训显著改善了附着点炎的临床评估，在日常临床实践中使用前应进行培训。超声显示了附着点炎的更晚期阶段，如附着骨赘和侵蚀，这些在临床检查中未被检测到。
