Ruyssen-Witrand Adeline, Jamard Bénédicte, Cantagrel Alain, Nigon Delphine, Loeuille Damien, Degboe Yannick, Constantin Arnaud
Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.
Inserm UMR1027, Toulouse, France.
RMD Open. 2017 Sep 7;3(2):e000482. doi: 10.1136/rmdopen-2017-000482. eCollection 2017.
To search for association between ultrasound (US) enthesis abnormalities and disease activity, spine and sacro-iliac joints (SIJ) MRI inflammatory lesions and spine structural changes in a cohort of patients suspected for axial spondyloarthritis (SpA).
Of 708 patients included in the DESIR(Devenir des Spondyloarthrites Indifférenciées Récentes) cohort, 402 had an US enthesis assessment and were selected for this study. Achilles, lateral epicondyles, superior patellar ligament, inferior patellar ligament entheses were systematically US scanned and abnormalities were summed in US structural and power Doppler (PDUS) scores. Spine radiographs, SIJ and spine MRI scans were centrally scored modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), presence of MRI sacro-iliitis, Spondyloarthritis Research Consortium of Canada and Berlin scores. The associations between the US structural/PDUS scores and disease activity, C reactive protein (CRP), MRI SIJ and spine inflammatory lesions and mSASSS were tested by Spearman's correlation tests.
Among the 402 patients included (median age: 33.5 years, males: 48.5%), 55% had US enthesis structural abnormalities while 14% had PDUS abnormalities. There was no association between US scores and Bath Ankylosing Spondylitis Disease Activity Index, CRP or inflammatory lesions on SIJ and spine MRI. There was a correlation between US structural and PDUS scores and the mSASSS (respectively, r=0.151, p=0.005; r=0.143, p=0.007). The proportion of patients with syndesmophytes was higher in the case of US enthesophytes (26% of syndesmophytes vs 6% in the absence of US enthesophytes, p<0.0001).
While the US abnormalities do not seem to be a helpful tool for monitoring disease activity in axial SpA, US enthesophytes, strongly associated with axial syndesmophytes, might be a marker of interest for disease severity.
NCT01648907, date of registration : 20 July 2012.
在一组疑似轴向型脊柱关节炎（SpA）的患者中，探寻超声（US）附着点异常与疾病活动度、脊柱和骶髂关节（SIJ）MRI炎症性病变以及脊柱结构变化之间的关联。
在纳入DESIR（新发未分化脊柱关节炎）队列的708例患者中，402例接受了US附着点评估并被选入本研究。对跟腱、外侧髁、髌上韧带、髌下韧带附着点进行系统的US扫描，并将异常情况汇总为US结构和能量多普勒（PDUS）评分。脊柱X线片、SIJ和脊柱MRI扫描由中心统一进行改良斯托克强直性脊柱炎脊柱评分（mSASSS）、MRI骶髂关节炎的存在情况、加拿大脊柱关节炎研究联盟和柏林评分。通过Spearman相关性检验来检测US结构/PDUS评分与疾病活动度、C反应蛋白（CRP）、MRI SIJ和脊柱炎症性病变以及mSASSS之间的关联。
在纳入的402例患者中（中位年龄：33.5岁，男性：48.5%），55%有US附着点结构异常，而14%有PDUS异常。US评分与巴斯强直性脊柱炎疾病活动指数、CRP或SIJ和脊柱MRI上的炎症性病变之间无关联。US结构和PDUS评分与mSASSS之间存在相关性（分别为r = 0.151，p = 0.005；r = 0.143，p = 0.007）。在存在US附着点骨赘的患者中，骨桥形成的比例更高（骨桥形成患者占26%，无US附着点骨赘患者占6%，p < 0.0001）。
虽然US异常似乎不是监测轴向型SpA疾病活动度的有用工具，但与轴向骨桥密切相关的US附着点骨赘可能是疾病严重程度的一个有意义的标志物。
NCT01648907，注册日期：2012年7月20日。
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