多普勒信号与附着点处的骨侵蚀与银屑病关节炎的超声关节侵蚀性损伤独立相关。

Doppler Signal and Bone Erosions at the Enthesis Are Independently Associated With Ultrasound Joint Erosive Damage in Psoriatic Arthritis.

作者信息

Smerilli Gianluca, Cipolletta Edoardo, Destro Castaniti Giulia Maria, Di Matteo Andrea, Di Carlo Marco, Moscioni Erica, Francioso Francesca, Mirza Riccardo Mashadi, Grassi Walter, Filippucci Emilio

机构信息

G. Smerilli, MD, E. Cipolletta, MD, A. Di Matteo, MD, PhD, M. Di Carlo, MD, E. Moscioni, MD, F. Francioso, MD, W. Grassi, MD, PhD, E. Filippucci, MD, PhD, Marche Polytechnic University, Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Jesi, Ancona;

出版信息

J Rheumatol. 2023 Jan;50(1):70-75. doi: 10.3899/jrheum.210974. Epub 2022 Feb 1.

DOI:10.3899/jrheum.210974

PMID:35105703

Abstract

OBJECTIVE

To explore the association of the Outcome Measures in Rheumatology ultrasound (US) entheseal abnormalities with the presence of US joint bone erosions in psoriatic arthritis (PsA).

METHODS

Consecutive patients with PsA were included in this cross-sectional study. Demographic and clinical variables were collected. A bilateral US assessment was carried out at the following entheses: plantar fascia, and the quadriceps, patellar (proximal and distal), and Achilles tendons. The following US entheseal abnormalities were registered: hypoechogenicity, thickening, Doppler signal < 2 mm from the bony cortex, calcification/enthesophyte, and bone erosion. The presence of US joint bone erosions was investigated at the second and fifth metacarpophalangeal joints, ulnar head, and fifth metatarsophalangeal (MTP) joint, bilaterally, as well as at the level of the most inflamed joint on physical examination. Multiple linear regression analysis was performed to identify clinical and/or US variables associated with US-detected joint bone erosions.

RESULTS

A total of 104 patients with PsA were enrolled. At least 1 joint bone erosion was found in 47 of 104 patients (45.2%). Bone erosions were most frequently detected at the fifth MTP joint level (42/208 joints [20.2 %] in 32/104 patients [30.8%]). In the multivariate model, only a power Doppler (PD) signal at the enthesis ( < 0.001, standardized β = 0.51), bone erosions at the enthesis ( = 0.02, standardized β = 0.20), PsA disease duration ( = 0.04, standardized β = 0.17), and greyscale joint synovitis ( = 0.03, standardized β = 0.42) were associated with US-detected joint bone erosions.

CONCLUSION

PD signal and bone erosions at the enthesis represent sonographic biomarkers of a more severe subset of PsA in terms of US-detected joint erosive damage.

摘要

目的

探讨风湿病超声（US）检查中附着点异常与银屑病关节炎（PsA）患者US关节骨侵蚀的相关性。

方法

本横断面研究纳入连续的PsA患者。收集人口统计学和临床变量。对以下附着点进行双侧US评估：足底筋膜、股四头肌、髌腱（近端和远端）以及跟腱。记录以下US附着点异常情况：低回声、增厚、距骨皮质<2mm处的多普勒信号、钙化/骨赘以及骨侵蚀。双侧检查第二和第五掌指关节、尺骨头和第五跖趾（MTP）关节以及体格检查中最炎症关节水平处是否存在US关节骨侵蚀。进行多元线性回归分析以确定与US检测到的关节骨侵蚀相关的临床和/或US变量。

结果

共纳入104例PsA患者。104例患者中有47例（45.2%）至少发现1处关节骨侵蚀。骨侵蚀最常出现在第五MTP关节水平（32/104例患者[30.8%]的208个关节中有42个[20.2%]）。在多变量模型中，仅附着点处的能量多普勒（PD）信号（<0.001，标准化β=0.51）、附着点处的骨侵蚀（=0.02，标准化β=0.20）、PsA病程（=0.04，标准化β=0.17）和灰阶关节滑膜炎（=0.03，标准化β=0.42）与US检测到的关节骨侵蚀相关。