Department of Rheumatology and Immunology, Medical University Graz, Auenbruggerplatz Graz, Austria.
Radiology Herne GbR, Hospitalstraße, Herne, Germany.
Rheumatology (Oxford). 2020 Oct 1;59(10):2893-2897. doi: 10.1093/rheumatology/keaa028.
The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA).
Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0-32) and power Doppler (0-14, range global ultrasound score 0-140)], and radiographs were evaluated for enthesophytes and erosions (score range 0-56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression.
We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P =0.005), had shorter disease duration (9.7 vs 17.9 years, P=0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P=0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P<0.05). The multivariate regression analysis revealed that 48.6% of the variance of the X-ray score at 12-months follow-up (RegcoeffB = 0.827, P=0.000) could be explained by the baseline US enthesophyte score.
Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses.
本前瞻性研究旨在探讨在银屑病关节炎（PsA）中，肌腱附着处的超声或临床异常是否可预测附着处的放射学进展。
连续纳入 PsA 患者，在基线时、6 个月和 12 个月时对 14 个肌腱附着处进行临床和超声评估。在 0 个月和 12 个月时进行 X 线摄影。通过 US，我们研究了结构（侵蚀、骨赘）和炎症变化[灰度（0-32）和功率多普勒（0-14，范围为超声总评分 0-140）]，并对附着处的骨赘和侵蚀进行了评估（评分范围 0-56）。进行多元回归模型以确定临床和超声发现与放射学进展的可能关联。
我们在基线时检查了 83 例患者，其中 43 例（51.8%）具有完整的临床、超声和 X 射线数据。43 例患者中有 24 例（55.8%）出现附着处的放射学进展。这些患者更年轻（49.6 岁 vs 59.3 岁，P=0.005），疾病持续时间更短（9.7 年 vs 17.9 年，P=0.015），6 个月时的临床疾病活动度更低[银屑病关节炎的疾病活动度（DAPSA）6.7 分 vs 17.0 分，P=0.018]，与未进展的患者相比。非进展者的基线时超声附着处骨赘评分高于进展者（20 分 vs 15 分，P<0.05）。多元回归分析显示，在 12 个月的随访中，X 射线评分的 48.6%的方差（RegcoeffB=0.827，P=0.000）可以用基线时的 US 附着处骨赘评分来解释。
我们的数据表明，附着处的放射学进展与年龄、疾病持续时间和基线时的超声证实的附着处骨赘有关。没有其他超声参数可以预测附着处的放射学进展。
