Relationship Between Ultrasound and Physical Examination in the Assessment of Enthesitis in Patients With Spondyloarthritis: Results From the DEUS Multicenter Study.
Andrea Di Matteo, Stefano Di Donato, Gianluca Smerilli, Andrea Becciolini, Federica Camarda, Alberto Cauli, Tomás Cazenave, Edoardo Cipolletta, Davide Corradini, Juan Jose de Agustin, Giulia M Destro Castaniti, Eleonora Di Donato, Emine Duran, Bayram Farisogullari, Marco Fornaro, Francesca Francioso, Pamela Giorgis, Raquel Granados, Amelia Granel, Cristina Hernandez-Diaz, Rudolf Horvath, Jana Hurnakova, Diogo Jesus, Omer Karadag, Ling Li, Yang Li, Maria G Lommano, Josefina Marin, María V Martire, Xabier Michelena, Laura Muntean, Matteo Piga, Marcos Rosemffet, João Rovisco, Fausto Salaffi, Liliana Saraiva, Crescenzio Scioscia, Maria-Magdalena Tamas, Shun Tanimura, Aliki Venetsanopoulou, Lucio Ventura Rios, Orlando Villota, Catalina Villota-Eraso, Paraskevi V Voulgari, Gentiana Vukatana, Johana Zacariaz Hereter, Walter Grassi, Emilio Filippucci
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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.
期刊介绍：
Arthritis & Rheumatology is the official journal of the American College of Rheumatology and focuses on the natural history, pathophysiology, treatment, and outcome of rheumatic diseases. It is a peer-reviewed publication that aims to provide the highest quality basic and clinical research in this field. The journal covers a wide range of investigative areas and also includes review articles, editorials, and educational material for researchers and clinicians. Being recognized as a leading research journal in rheumatology, Arthritis & Rheumatology serves the global community of rheumatology investigators and clinicians.
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