M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, and Department of Clinical Medicine, Faculty for Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
W.P. Maksymowych, MD, MB ChB, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Rheumatol. 2023 Nov;50(Suppl 2):18-22. doi: 10.3899/jrheum.2023-0518. Epub 2023 Jul 7.
Enthesitis is a key disease manifestation in patients with psoriatic arthritis (PsA) that considerably contributes to pain, lower physical function, and reduced quality of life. Clinical assessment of enthesitis lacks sensitivity and specificity, and therefore better methods are urgently needed. Magnetic resonance imaging (MRI) allows detailed assessment of the components of enthesitis, and consensus-based validated MRI scoring systems exist. These include the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis MRI Scoring System (HEMRIS) method, which assesses the entheses of the heel region in a detailed manner, and the OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses (MRI-WIPE) method, which provides an overall assessment of the inflammatory burden in the peripheral entheses and joints in the entire body using whole-body MRI. At an MRI workshop at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2022 meeting in Brooklyn, the MRI appearances of peripheral enthesitis were described, as were the scoring methods. The utility of MRI for improved assessment of enthesitis was demonstrated with examples of patient cases. Clinical trials in PsA that evaluate enthesitis by MRI as a key endpoint should include the presence of MRI enthesitis as an inclusion criterion, and apply validated MRI outcomes to assess the effect of therapeutics on enthesitis are recommended.
附着点炎是银屑病关节炎（PsA）患者的主要疾病表现之一，它会导致明显的疼痛、身体功能下降和生活质量降低。临床评估附着点炎的方法缺乏敏感性和特异性，因此迫切需要更好的方法。磁共振成像（MRI）可以详细评估附着点炎的各个组成部分，并且存在基于共识的经过验证的 MRI 评分系统。其中包括风湿病疗效测量标准（OMERACT）足跟附着点炎 MRI 评分系统（HEMRIS），它详细评估足跟区域的附着点炎，以及 OMERACT MRI 全身外周关节和附着点炎炎症评分（MRI-WIPE）系统，它使用全身 MRI 对整个身体的外周附着点炎和关节的炎症负担进行整体评估。在 2022 年布鲁克林 GRAPPA 会议的一个 MRI 研讨会上，描述了外周附着点炎的 MRI 表现和评分方法。通过患者病例示例展示了 MRI 用于改善附着点炎评估的实用性。建议在评估 MRI 作为关键终点的附着点炎的 PsA 临床试验中，应将 MRI 附着点炎的存在作为纳入标准，并应用经过验证的 MRI 结果来评估治疗对附着点炎的效果。
