Hospital Universitario Ramón y Cajal, Madrid, Spain.
Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain.
Acad Radiol. 2024 Oct;31(10):4152-4158. doi: 10.1016/j.acra.2024.04.021. Epub 2024 May 24.
The goal of achieving clinical remission in patients with spondyloarthritis does not necessarily include the resolution of entheseal inflammation from a histological perspective. However, enthesis not clinically inflamed, under mechanical stress, may behave differently from healthy subjects considering the physiopathology of SpA. Our goal was to determine whether ultrasound changes in entheses differ between SpA patients in clinical remission and healthy subjects.
SpA patients in clinical remission and matched healthy controls were recruited. At baseline, the following variables were measured on the dominant side by ultrasound: thickness of the distal patellar enthesis (hDP), the deep infrapatellar bursa (hDIB), the Achilles enthesis (hA), the preachilleal bursa (hPAB), effusion in the preachileal bursa (hePAB), and the presence of power Doppler signal in both enthesis. All measurements except hDP and hA were collected again after exercise (post-stress ultrasound).
30 patients and 30 controls were enrolled. In all subjects, hDIB, hPAB, and the preachileal bursa occupancy index increased significantly after the exercise. The increase was significantly greater in patients for all variables. At baseline, in patients, hyperemia was detected in one patellar tendon (3.3%) and in two Achilles tendons (6.7%). After exercise, the number of tendons with hyperemia increased to 11/30 (36.7%) and 12/30 (40%), respectively. Among controls, there was no detectable basal hyperemia, but after exercise, it was detected in 1/30 patellar tendons (3.3%) and 2/30 Achilles tendons (6.7%).
Exercise triggers a greater effusive and hyperemic synovial response in patients in remission than in healthy controls. These findings suggest that the definition of remission should also include an assessment of the synovial response to mechanical stress.
强直性脊柱炎（SpA）患者的临床缓解目标并不一定包括从组织学角度解决附着点炎症。然而，从 SpA 的病理生理学角度考虑，在机械应力下，即使附着点没有临床炎症，其表现也可能与健康受试者不同。我们的目的是确定临床缓解的 SpA 患者与健康受试者之间，附着点的超声变化是否存在差异。
招募了临床缓解的 SpA 患者和匹配的健康对照者。在基线时，通过超声在优势侧测量以下变量：髌腱末端（hDP）厚度、髌下深囊（hDIB）、跟腱附着点（hA）、髌前囊（hPAB）、髌前囊积液（hePAB）和附着点的功率多普勒信号。除 hDP 和 hA 外，所有测量值均在运动后（应激后超声）再次进行。
共纳入 30 例患者和 30 例对照者。在所有受试者中，hDIB、hPAB 和髌前囊占有率指数在运动后均显著增加。所有变量的增加在患者中均显著更大。在基线时，在 3 例患者（10%）中检测到 1 条髌腱（3.3%）和 2 条跟腱（6.7%）出现充血。运动后，出现充血的肌腱数量分别增加至 30 例患者中的 11 条（36.7%）和 12 条（40%）。在对照者中，基线时未检测到可察觉的充血，但运动后，在 30 例对照者中，有 1 条髌腱（3.3%）和 2 条跟腱（6.7%）出现充血。
运动在缓解期患者中引发的滑液渗出和充血反应比健康对照组更强烈。这些发现表明，缓解的定义还应包括对机械应激下滑膜反应的评估。
