From the University of Toronto and Toronto Western Hospital; University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; University Health Network; Women's College Hospital, Toronto; University of Ottawa, Faculty of Medicine, Rheumatology, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.
O. Elalouf, MD, Clinical Research Fellow, University of Toronto and Toronto Western Hospital; S. Bakirci Ureyen, MD, Clinical Research Fellow, University of Ottawa, Faculty of Medicine, Rheumatology; Z. Touma, MD, PhD, FACP, FACR, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; M. Anderson, BAH MLIS, Information Specialist, University Health Network; G.S. Kaeley, MBBS, MRCP, Professor of Medicine, Division of Rheumatology, University of Florida College of Medicine; S.Z. Aydin, MD, Associate Professor of Medicine, University of Ottawa, Ottawa Hospital Research Institute; L. Eder, MD, PhD, Assistant Professor of Medicine, University of Toronto and Women's College Hospital.
J Rheumatol. 2019 Jan;46(1):43-56. doi: 10.3899/jrheum.171466. Epub 2018 Jul 15.
As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound working group, we performed a systematic review of the literature to assess the evidence and knowledge gaps in scoring instruments of enthesitis in psoriatic arthritis (PsA).
A systematic search of PubMed, EMBase, and Cochrane databases was performed. The search strategy was constructed to find original publications containing terms related to ultrasound, enthesitis, spondyloarthritis (SpA) or PsA. Data extraction focused on the properties of the sonographic enthesitis instruments used in each study following components of the Outcome Measures in Rheumatology (OMERACT) filter: feasibility, test-retest reliability, construct validity as related to clinical assessment of enthesitis, biomarkers of inflammation and imaging of enthesitis by other modalities, discriminative validity, and responsiveness to treatment.
Fifty-one of 310 identified manuscripts were included. Only 1 scoring instrument of enthesitis was specifically developed and validated in patients with PsA. Only 18 (35%) of the studies involved patients with PsA, while the remaining studies focused on SpA. In PsA, construct validity was assessed using biomarkers and clinical examination in 1 (2%) and 11 (21.5%) of the studies, respectively, whereas no studies used imaging for the same purpose. Only 2 (4%) of the studies assessed discriminative validity in PsA. Responsiveness to treatment was assessed in 7 studies, none of which included patients with PsA.
Although sonographic enthesitis scoring instruments have been developed for SpA, only a few have been validated in PsA. None of them passed the OMERACT filter in patients with PsA. Additional research is required before endorsing a specific instrument for the assessment of enthesitis in patients with PsA.
作为 GRAPPA（银屑病和银屑病关节炎研究与评估小组）超声工作组的一部分，我们对文献进行了系统回顾，以评估在银屑病关节炎（PsA）中评估附着点炎的评分工具的证据和知识空白。
对 PubMed、EMBase 和 Cochrane 数据库进行了系统检索。该搜索策略的构建是为了找到包含与超声、附着点炎、脊柱关节炎（SpA）或 PsA 相关术语的原始出版物。数据提取主要集中在每个研究中使用的超声附着点炎仪器的特性上，这些特性遵循 OMERACT（风湿病结局测量）过滤器的组成部分：可行性、测试-重测可靠性、与附着点炎的临床评估相关的结构有效性、炎症的生物标志物和其他方式的附着点炎影像学、判别有效性和对治疗的反应性。
从 310 篇已确定的文献中，有 51 篇被纳入。仅有 1 种专门针对 PsA 患者开发和验证的附着点炎评分工具。只有 18 项（35%）研究涉及 PsA 患者，而其余研究则侧重于 SpA。在 PsA 中，11 项（21.5%）研究分别使用生物标志物和临床检查评估了结构有效性，而没有研究使用影像学进行同样的目的。只有 2 项（4%）研究在 PsA 中评估了判别有效性。7 项研究评估了治疗反应性，其中没有一项包括 PsA 患者。
虽然已经为 SpA 开发了超声附着点炎评分工具，但只有少数在 PsA 中得到验证。在 PsA 患者中，没有一种工具通过了 OMERACT 过滤器。在支持特定工具用于评估 PsA 患者的附着点炎之前，需要进行更多的研究。
