Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan.
Clin Exp Rheumatol. 2021 Jan-Feb;39(1):139-145. doi: 10.55563/clinexprheumatol/u8qc6c. Epub 2020 Apr 17.
Enthesitis is a major musculoskeletal manifestation of psoriatic arthritis (PsA). It is conventionally assessed clinically, by the presence of tenderness, despite its low reliability. However, ultrasound (US) provides a sensitive and feasible method for evaluating enthesitis. We investigated enthesitis as assessed clinically and by US in patients with PsA.
Forty-seven patients with PsA underwent US examination of the bilateral humeral medial epicondyles and insertions of the triceps, distal quadriceps, proximal/distal patellae, Achilles tendons, and plantar fascia. These 14 entheses were also clinically evaluated by tenderness. The correspondence between US and clinical enthesitis was evaluated, as well as their associations with inflammatory markers (C-reactive protein [CRP], matrix metalloproteinase-3 [MMP-3]), disease activity indices (Disease Activity in Psoriatic Arthritis [DAPSA], Disease Activity Score 28 joints [DAS28-CRP], Psoriatic Arthritis Screening and Evaluation [PASE], Psoriasis Area Severity Index [PASI]), radiographic damage (modified Total Sharp Score [mTSS]), and functional status (health assessment questionnaire [HAQ]), and axial involvement.
Among 47 patients with PsA, 37 and 23 had US and clinical enthesitis, respectively. US and clinical enthesitis had very low concordance (kappa coefficient 0.04), with no correlation between enthesitis counts (r=0.15, p=0.30). The US enthesitis count correlated only with the MMP-3 level (r=0.41, p=0.007), whereas the clinical enthesitis count correlated with the DAPSA, DAS28-CRP, HAQ, and PASE (r=0.50, p<0.001; r=0.44, p=0.002; r=0.41, p=0.008; r=0.54, p<0.001, respectively).
US and clinical enthesitis are completely different entities. US enthesitis, but not clinical enthesitis, reflects inflammatory conditions.
附着点炎是银屑病关节炎（PsA）的主要肌肉骨骼表现。尽管其可靠性较低，但临床上通常通过压痛来评估附着点炎。然而，超声（US）为评估附着点炎提供了一种敏感且可行的方法。我们调查了 PsA 患者的临床和 US 评估的附着点炎。
47 例 PsA 患者接受了双侧肱骨内侧髁和三头肌、远端四头肌、近端/远端髌骨、跟腱和足底筋膜附着点的 US 检查。这 14 个附着点也通过压痛进行了临床评估。评估了 US 和临床附着点炎之间的一致性，以及它们与炎症标志物（C 反应蛋白[CRP]、基质金属蛋白酶-3 [MMP-3]）、疾病活动指数（银屑病关节炎疾病活动度[DAPSA]、28 关节疾病活动度[DAS28-CRP]、银屑病关节炎筛查和评估[PASE]、银屑病面积严重程度指数[PASI]）、放射学损伤（改良总Sharp 评分[mTSS]）和功能状态（健康评估问卷[HAQ]）以及轴向受累的相关性。
在 47 例 PsA 患者中，37 例和 23 例分别有 US 和临床附着点炎。US 和临床附着点炎的一致性非常低（kappa 系数 0.04），附着点炎计数之间没有相关性（r=0.15，p=0.30）。US 附着点炎计数仅与 MMP-3 水平相关（r=0.41，p=0.007），而临床附着点炎计数与 DAPSA、DAS28-CRP、HAQ 和 PASE 相关（r=0.50，p<0.001；r=0.44，p=0.002；r=0.41，p=0.008；r=0.54，p<0.001）。
US 和临床附着点炎是完全不同的实体。US 附着点炎，但不是临床附着点炎，反映了炎症情况。
