Di Matteo Andrea, Di Donato Stefano, Filippucci Emilio
Rheumatology Unit, 'Carlo Urbani' Hospital, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
Rheumatology Department, University of Leeds Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
RMD Open. 2025 Apr 28;11(2):e005496. doi: 10.1136/rmdopen-2025-005496.
(1) To develop a composite score, the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) Enthesitis Index (DEI), which integrates ultrasound and clinical examination findings for enthesitis assessment in patients with spondyloarthritis (SpA); (2) to examine the relationships between DEI and clinical features in this population, compared to the clinical examination of the entheses alone.
This was a cross-sectional, observational, multicentric study involving 20 rheumatology centres across 11 countries. Ultrasound and clinical examinations were performed bilaterally on the lower limb large entheses (ie, quadriceps tendon, proximal and distal patellar tendons, Achilles tendon and plantar fascia) in 413 patients with SpA, including 224 patients with axial SpA and 189 patients with psoriatic arthritis (PsA). A score of 1.0 for clinical enthesitis and 1.0 for ultrasound enthesitis was assigned for each of the 10 entheses evaluated. The total DEI score, which combines clinical and ultrasound findings, ranged from 0 to 20 per patient. Logistic and gamma regression models based on DEI were compared with those derived solely from clinical enthesitis assessment to evaluate their relative performance in explaining disease-related outcomes.
Among patients with SpA, the median DEI was 1.0 (IQR 0.0-3.0). DEI showed significant associations with SpA disease activity and severity indices in regression analyses, except for the Disease Activity in Psoriatic Arthritis score in patients with PsA. Compared with the clinical examination alone of the same entheses, DEI models exhibited a significantly better fit with C-reactive protein levels and ultrasound-detected structural damage at the enthesis (ie, enthesophytes and bone erosions). By contrast, the clinical examination alone models showed a significantly stronger fit with SpA disease activity indices and patient-reported outcomes compared with the DEI.
DEI is a novel tool that integrates both ultrasound and clinical examination findings for enthesitis assessment, potentially ensuring a more reliable evaluation of this key domain in SpA.
（1）制定一个综合评分，即脊柱关节炎超声定义附着点炎（DEUS）附着点炎指数（DEI），用于整合超声和临床检查结果，以评估脊柱关节炎（SpA）患者的附着点炎；（2）与单独的附着点临床检查相比，研究该人群中DEI与临床特征之间的关系。
这是一项横断面、观察性、多中心研究，涉及11个国家的20个风湿病中心。对413例SpA患者的下肢大附着点（即股四头肌肌腱、髌腱近端和远端、跟腱和跖腱膜）进行双侧超声和临床检查，其中包括224例轴向SpA患者和189例银屑病关节炎（PsA）患者。对评估的10个附着点中的每一个，临床附着点炎评分为1.0，超声附着点炎评分为1.0。结合临床和超声检查结果的DEI总分，每位患者的范围为0至20分。将基于DEI的逻辑回归模型和伽马回归模型与仅从临床附着点炎评估得出的模型进行比较，以评估它们在解释疾病相关结局方面的相对表现。
在SpA患者中，DEI的中位数为1.0（四分位间距0.0 - 3.0）。在回归分析中，DEI与SpA疾病活动度和严重程度指数显著相关，但PsA患者的银屑病关节炎疾病活动度评分除外。与相同附着点的单独临床检查相比，DEI模型与C反应蛋白水平以及附着点处超声检测到的结构损伤（即附着点骨赘和骨侵蚀）的拟合度明显更好。相比之下，单独的临床检查模型与SpA疾病活动度指数和患者报告结局的拟合度明显强于DEI。
DEI是一种整合超声和临床检查结果用于附着点炎评估的新工具，可能确保对SpA这一关键领域进行更可靠的评估。
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