Sapsford Mark, Evans Jobie, Clunie Gavin, Jadon Deepak
Department of Rheumatology, Cambridge University Hospitals NHSFT, Cambridge, UK.
Rheumatology Research Unit, Addenbrooke's Hospital, Cambridge University Hospital Trust, Hills Road, Cambridge CB2 0QQ, UK.
Ther Adv Musculoskelet Dis. 2021 Mar 29;13:1759720X211003812. doi: 10.1177/1759720X211003812. eCollection 2021.
To: (a) determine the extent of ultrasound (US)-detected peripheral enthesitis in a cohort of patients with psoriatic arthritis (PsA); (b) compare this with three clinical examination (CE) enthesitis indices; and (c) determine the effect of concurrent fibromyalgia on the evaluation of enthesitis.
A prospective single-centre cross-sectional study of consecutive outpatients with established PsA undergoing clinical examination for enthesitis and US examination for inflammatory and structural lesions of enthesitis. Multivariable analyses tested for association between US scores, CE enthesitis indices and influence of concurrent fibromyalgia.
A total of 106 patients were assessed. Of these, 91/106 (85.8%) had CE enthesitis and 105/106 (99.1%) had ⩾1 US feature of enthesitis. There was a moderate correlation between US entheseal inflammation and both the Leeds Enthesitis Index (LEI) (Spearman rank, = 0.36) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) ( = 0.44). US entheseal damage did not correlate with CE enthesitis indices. Twenty-eight (26.4%) patients were classified as having concurrent fibromyalgia, in whom multivariable regression analyses demonstrated no correlation between US scores and CE enthesitis indices. PsA patients without fibromyalgia demonstrated a statistically significant association between both LEI ( = 0.48, < 0.0001) and SPARCC ( = 0.62, < 0.0001) and US entheseal inflammation.
There is a moderate association between US entheseal inflammation, but not damage, and CE enthesitis indices in patients with PsA. The presence of concurrent fibromyalgia is linked with higher CE enthesitis scores, without an increase in US inflammation, suggesting that CE enthesitis indices should be used/interpreted with caution in these patients. Imaging, including US, should be the preferred modality to detect enthesitis in PsA patients with concurrent fibromyalgia.
(a) 确定在一组银屑病关节炎（PsA）患者中超声（US）检测到的外周附着点炎的程度；(b) 将其与三种临床检查（CE）附着点炎指数进行比较；(c) 确定合并纤维肌痛对附着点炎评估的影响。
一项前瞻性单中心横断面研究，纳入连续的确诊PsA门诊患者，对其进行附着点炎的临床检查以及附着点炎的炎症和结构损伤的超声检查。多变量分析检测超声评分、CE附着点炎指数之间的关联以及合并纤维肌痛的影响。
共评估了106例患者。其中，91/106（85.8%）有CE附着点炎，105/106（99.1%）有≥1项超声附着点炎特征。超声附着点炎症与利兹附着点炎指数（LEI）（Spearman等级相关系数，r = 0.36）和加拿大脊柱关节炎研究联盟附着点炎指数（SPARCC）（r = 0.44）均呈中度相关。超声附着点损伤与CE附着点炎指数无相关性。28例（26.4%）患者被分类为合并纤维肌痛，多变量回归分析显示这些患者的超声评分与CE附着点炎指数无相关性。无纤维肌痛的PsA患者中，LEI（r = 0.48，P < 0.0001）和SPARCC（r = 0.62，P < 0.0001）与超声附着点炎症之间均存在统计学显著关联。
在PsA患者中，超声附着点炎症与CE附着点炎指数之间存在中度关联，但与附着点损伤无关。合并纤维肌痛与更高的CE附着点炎评分相关，而超声炎症无增加，这表明在这些患者中使用/解释CE附着点炎指数时应谨慎。包括超声在内的影像学检查应是检测合并纤维肌痛的PsA患者附着点炎的首选方式。
