超声与体格检查在脊柱关节炎患者附着点炎评估中的关系：DEUS多中心研究结果

Relationship Between Ultrasound and Physical Examination in the Assessment of Enthesitis in Patients With Spondyloarthritis: Results From the DEUS Multicenter Study.

作者信息

Di Matteo Andrea, Di Donato Stefano, Smerilli Gianluca, Becciolini Andrea, Camarda Federica, Cauli Alberto, Cazenave Tomás, Cipolletta Edoardo, Corradini Davide, de Agustin Juan Jose, Destro Castaniti Giulia M, Di Donato Eleonora, Duran Emine, Farisogullari Bayram, Fornaro Marco, Francioso Francesca, Giorgis Pamela, Granados Raquel, Granel Amelia, Hernandez-Diaz Cristina, Horvath Rudolf, Hurnakova Jana, Jesus Diogo, Karadag Omer, Li Ling, Li Yang, Lommano Maria G, Marin Josefina, Martire María V, Michelena Xabier, Muntean Laura, Piga Matteo, Rosemffet Marcos, Rovisco João, Salaffi Fausto, Saraiva Liliana, Scioscia Crescenzio, Tamas Maria-Magdalena, Tanimura Shun, Venetsanopoulou Aliki, Ventura Rios Lucio, Villota Orlando, Villota-Eraso Catalina, Voulgari Paraskevi V, Vukatana Gentiana, Zacariaz Hereter Johana, Grassi Walter, Filippucci Emilio

机构信息

"Carlo Urbani" Hospital and Polytechnic University of Marche, Ancona, Italy, and University of Leeds, Leeds, United Kingdom.

University of Leeds, NIHR Leeds BRC, Leeds, United Kingdom.

出版信息

Arthritis Rheumatol. 2025 Jan;77(1):22-33. doi: 10.1002/art.42971. Epub 2024 Oct 15.

DOI:10.1002/art.42971

PMID:39165013

Abstract

OBJECTIVE

The study objectives were (i) to explore the agreement between the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and physical examination in assessing enthesitis in patients with spondyloarthritis (SpA) and (ii) to investigate the prevalence and clinical relevance of subclinical enthesitis in this population.

METHODS

Twenty rheumatology centers participated in this cross-sectional study. Patients with SpA, including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), underwent both ultrasound scan and physical examination of large lower limb entheses. The OMERACT ultrasound lesions of enthesitis were considered, along with a recently proposed definition for "active enthesitis" by our group. Subclinical enthesitis was defined as the presence of "active enthesitis" in ≥1 enthesis in patients with SpA without clinical enthesitis (ie, number of positive entheses on physical examination and Leeds Enthesitis Index score = 0).

RESULTS

A total of 4,130 entheses in 413 patients with SpA (224 with axSpA and 189 with PsA) were evaluated through ultrasound and physical examination. Agreement between ultrasound and physical examination ranged from moderate (ie, enthesophytes) to almost perfect (ie, power Doppler and "active enthesitis"). Patellar tendon entheses demonstrated the highest agreement, whereas Achilles tendon insertion showed the lowest. Among 158 (38.3%) of 413 patients with SpA with clinical enthesitis, 108 (68.4%) exhibited no "active enthesitis" on ultrasound. Conversely, of those 255 without clinical enthesitis, 39 (15.3%) showed subclinical enthesitis. Subclinical enthesitis was strongly associated with local structural damage. However, no differences were observed regarding the demographic and clinical profiles of patients with SpA with and without subclinical enthesitis.

CONCLUSION

Our study underscores the need for a comprehensive tool integrating ultrasound and physical examination for assessing enthesitis in patients with SpA.

摘要

目的

本研究的目的是：（i）探讨风湿病结局评估（OMERACT）超声检查的附着点炎病变与体格检查在评估脊柱关节炎（SpA）患者附着点炎方面的一致性；（ii）调查该人群中亚临床附着点炎的患病率及临床相关性。

方法

20个风湿病中心参与了这项横断面研究。SpA患者，包括轴性脊柱关节炎（axSpA）和银屑病关节炎（PsA），接受了下肢大关节附着点的超声扫描和体格检查。考虑了OMERACT超声检查的附着点炎病变，以及我们团队最近提出的“活动性附着点炎”定义。亚临床附着点炎定义为SpA患者中无临床附着点炎（即体格检查和利兹附着点炎指数评分 = 0时阳性附着点的数量）但≥1个附着点存在“活动性附着点炎”。

结果

通过超声和体格检查对413例SpA患者（224例axSpA和189例PsA）的总共4130个附着点进行了评估。超声检查与体格检查之间的一致性从中度（即骨赘）到几乎完美（即能量多普勒和“活动性附着点炎”）不等。髌腱附着点的一致性最高，而跟腱附着点的一致性最低。在413例有临床附着点炎的SpA患者中，158例（38.3%）在超声检查中未表现出“活动性附着点炎”。相反，在255例无临床附着点炎的患者中，39例（15.3%）表现出亚临床附着点炎。亚临床附着点炎与局部结构损伤密切相关。然而，有和没有亚临床附着点炎的SpA患者在人口统计学和临床特征方面未观察到差异。