Department of Rheumatology, Gregorio Marañón University Hospital, Madrid, Spain.
Department of Rheumatology, Severo Ochoa University Hospital, Madrid, Spain.
Clin Rheumatol. 2021 May;40(5):2013-2020. doi: 10.1007/s10067-020-05450-4. Epub 2020 Oct 9.
To analyse the frequency of power Doppler (PD) enthesitis in active axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients and its potential usefulness in clinical practice.
A prospective multicentre cross-sectional study in patients with axSpA and PsA with active disease was undertaken. Patients underwent bilateral ultrasound (US) examination of the peripheral entheses according to the Madrid Sonographic Enthesis Index (MASEI). The MASEI and Outcome Measures in Rheumatology (OMERACT) PD enthesitis definitions were checked. An inter-reader analysis of recorded videos was performed to determine reliability.
Sixty-four consecutive patients were included. The mean DAS28 (3.9 ± 1.3) for peripheral involvement, mean BASDAI (5.6 ± 2.2) for axial involvement, and CRP values (10 ± 10.9) reflected moderate-high disease activity at baseline. The mean global MASEI score was 29.4 (± 11.4), and 55 patients (86%) scored ≥ 18 (proposed cut-off point to diagnose SpA). At the patient level, abnormal US findings consistent with at least one enthesis showing a PD signal were observed in 52 (81.3%) patients using the MASEI PD definition and 48 (75%) using the OMERACT PD definition, without significant variation between axSpA and PsA. The inter-reader reliability was excellent (kappa = 0.92 for MASEI PD and 0.86 for OMERACT PD).
PD enthesitis was found in the majority of patients with active axSpA and PsA, independent of axial or peripheral affectation. Both MASEI and OMERACT PD definitions were useful in detecting active enthesitis. These findings support the usefulness of a PD US evaluation of entheses in the assessment of axSpA and PsA. Key Points • PD enthesitis is a very common finding in patients with active axSpA and PsA • Both MASEI and OMERACT PD definitions are useful to detect active enthesitis • US enthesitis may reveal information in axSpA and PsA.
分析活跃型中轴型脊柱关节炎（axSpA）和银屑病关节炎（PsA）患者的能量多普勒（PD）肌腱附着点炎的频率及其在临床实践中的潜在用途。
对患有活动性 axSpA 和 PsA 的患者进行了一项前瞻性多中心横断面研究。根据马德里超声肌腱附着点指数（MASEI），对患者进行双侧外周肌腱附着点超声检查。检查 MASEI 和风湿病结局测量（OMERACT）PD 肌腱附着点炎定义。对记录的视频进行了读者间分析，以确定可靠性。
共纳入 64 例连续患者。外周受累的平均 DAS28（3.9±1.3）、轴性受累的平均 BASDAI（5.6±2.2）和 CRP 值（10±10.9）反映了基线时的中高度疾病活动度。平均全球 MASEI 评分为 29.4（±11.4），55 例（86%）患者评分≥18（诊断 SpA 的建议切点）。在患者水平上，使用 MASEI PD 定义观察到 52 例（81.3%）患者和使用 OMERACT PD 定义观察到 48 例（75%）患者至少有一个肌腱附着点出现 PD 信号的异常超声表现，axSpA 和 PsA 之间无显著差异。读者间可靠性极好（MASEI PD 的 Kappa 值为 0.92，OMERACT PD 的 Kappa 值为 0.86）。
活跃型 axSpA 和 PsA 患者的大多数患者均存在 PD 肌腱附着点炎，与轴性或外周受累无关。MASEI 和 OMERACT PD 定义均有助于检测活跃性肌腱附着点炎。这些发现支持在评估 axSpA 和 PsA 时使用 PD 超声评估肌腱附着点的有用性。
PD 肌腱附着点炎是活跃型 axSpA 和 PsA 患者的常见表现。
MASEI 和 OMERACT PD 定义均有助于检测活跃性肌腱附着点炎。
US 肌腱附着点炎可在 axSpA 和 PsA 中提供信息。
