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Tharwat S, Saleh M, Elrefaey R, Nassar MK, Nassar MK. Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2181. [PMID: 38138284 PMCID: PMC10744597 DOI: 10.3390/medicina59122181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
| | - Marwa Saleh
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Rabab Elrefaey
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura 35516, Egypt;
| | - Mohammed Kamal Nassar
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
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Fırat SN, Kuşkonmaz ŞM, Önder ÇE, Omma T, Genç H, Çulha C. Sonographic evaluation of subclinical entheseal involvement in patients with hypoparathyroidism: a case control study. J Endocrinol Invest 2023; 46:133-139. [PMID: 35982371 DOI: 10.1007/s40618-022-01891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/29/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Hypoparathyroidism is a disease characterized by low serum calcium, increased serum phosphorus and low PTH levels. Although patients are treated with active vitamin D and calcium, a proper serum calcium phosphorus balance cannot always be achieved. Ectopic calcifications that develop in organs during treatment are the most common complications. To date, there is not any published study on enthesopathy in patients with hypoparathyroidism. The aim of this study was to evaluate subclinical enthesopathy in patients with hypoparathyroidism with ultrasound and to compare the results with those of the control group. METHODS The study included patients aged 18-65 years with postoperative hypoparathyroidism and hypothyroidism (group hypoP + hypoT), patients with postoperative hypothyroidism (group hypoT), and healthy age and sex-matched volunteers (group C). Ultrasonographic findings of enthesopathy in both extremities were documented according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS GUESS scores in group hypoP + hypoT, were significantly higher when compared to the other groups. There was a statistically significant correlation between the total GUESS scores and total enthesophyte scores and the duration of hypoparathyroidism (p < 0.05, r = 0.43) (p < 0.05, r = 0.39) respectively. In the correlation analysis of all groups, a significant negative correlation was found between serum Ca and PTH levels and the total GUESS scores (p < 0.01, r = - 0.37; p < 0.01, r = - 0.54, respectively). CONCLUSION This study showed that GUESS scores were significantly higher in patients with hypoparathyroidism compared to those with hypothyroidism and control subjects. GUESS scores were positively correlated with disease duration. Patients with hypoparathyroidism need to be evaluated for subclinical enthesopathy during follow-up.
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Affiliation(s)
- S N Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey.
| | - Ş M Kuşkonmaz
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
| | - Ç E Önder
- Department of Endocrinology and Metabolism, Niğde Ömer Halisdemir University Training and Research Hospital, Niğde, Turkey
| | - T Omma
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
| | - H Genç
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - C Çulha
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
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Mutlu S, Erdem Toslak I, Inci A, Cekic B, Yavuz A. Evaluation of the Achilles Tendon Using B-Mode Ultrasound and Strain Elastography in Patients With Chronic Kidney Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:771-778. [PMID: 32856750 DOI: 10.1002/jum.15453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the B-mode ultrasound (US) features and elasticity of the Achilles tendon in patients with chronic kidney disease (CKD) using US elastography and to compare them with those of healthy individuals. METHODS From March 2019 through May 2019, 30 consecutive patients with variable stages of CKD and 30 healthy individuals were prospectively included in this study. Ultrasound and strain elastographic examinations were performed on both Achilles tendons of all individuals. Degrees of tendinopathy, if existed, were classified as defined by Archambault et al (J Clin Ultrasound 1998; 26:335-339), and thicknesses were documented with US. Strain ratios (SRs) were calculated by measuring the strain values from the Achilles tendon and Kager fat pad. Statistical differences in the SRs of Achilles tendons between the control group and patients with CKD were calculated. RESULTS The 30 patients with CKD ranged in age from 24 to 73 years, and the 30 healthy individuals ranged in age from 25 to 78 years. Both distal and left middle thirds of the Achilles tendons were thicker in patients with CKD than in healthy individuals (P < .05). The mean SRs ± SDs in the patient group (4.71 ± 0.95 and 4.85 ± 1.47 on the right and left, respectively) were significantly higher (P < .05) than in healthy individuals (2.31 ± 0.42 and 2.65 ± 0.55 on the right and left), which indicated an increased stiffness of Achilles tendons in the patient group. CONCLUSIONS As a semiquantitative and noninvasive imaging modality, strain elastography has the potential to detect the morphologic and elasticity changes of Achilles tendons in patients with CKD, which may give an opportunity to help physicians predict possible leading partial or complete tears.
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Affiliation(s)
- Samet Mutlu
- Department of Radiology, University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Iclal Erdem Toslak
- Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Ayca Inci
- Department of Internal Medicine Division of Nephrology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Bulent Cekic
- Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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Evaluation of the thicknesses of cartilage and enthesis in familial Mediterranean fever and enthesitis-related arthritis. North Clin Istanb 2020; 7:591-596. [PMID: 33381699 PMCID: PMC7754861 DOI: 10.14744/nci.2020.54037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE: Subclinical inflammation is still a controversial issue in inflammatory diseases. There is no reliable, easy, and cheap inflammation marker in daily clinical practices currently. This study aims to predict clinical remission using cartilage and tendon thicknesses. METHODS: Eleven patients with Familial Mediterranean Fever (FMF) who had musculoskeletal involvement before and 11 patients with Enthesitis-Related Arthritis (ERA) were included in this study. They were on remission with clinical and laboratory evaluations for at least three months. Demographic and clinical features of the subjects, including age, sex, body mass index, disease duration, age at onset, medical treatment, and laboratory evaluations, were all noted. Healthy children of the same age were included as the control group. The thicknesses of the bilateral knee, second metacarpophalangeal and ankle joints cartilages, quadriceps, superior and inferior patellar, and the Achilles tendons were measured with a linear probe. A total of 198 joint and 264 tendon thicknesses were measured. RESULTS: The thicknesses of metacarpophalangeal, knee, and ankle cartilages were higher in the FMF group than in the others. In the FMF group, the quadriceps tendon thickness was higher than in the ERA group, and the superior patellar tendon thickness was higher than in the control group (p<0.05). CONCLUSION: According to our preliminary findings, an increased thickness of the cartilage and tendon in FMF patients may be an indicator of subclinical inflammation. Increased thickness of the enthesis in FMF patients may also indicate that enthesitis-related arthritis will also develop in the future.
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Achilles Tendon Thickness and Stiffness Evaluation with Shear-Wave Elastography in Hemodialysis Patients. IRANIAN JOURNAL OF RADIOLOGY 2019. [DOI: 10.5812/iranjradiol.66274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Okur SC, Dogan YP, Mert M, Aksu O, Burnaz O, Caglar NS. Ultrasonographic Evaluation of Lower Extremity Entheseal Sites in Diabetic Patients Using Glasgow Ultrasound Enthesitis Scoring System Score. J Med Ultrasound 2018; 25:150-156. [PMID: 30065480 PMCID: PMC6029304 DOI: 10.1016/j.jmu.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/01/2017] [Indexed: 01/15/2023] Open
Abstract
Objective The prevalence of musculoskeletal complications in diabetes mellitus (DM) increases with the duration of disease and with poor glycemic control. Our aim was to evaluate lower extremity musculoskeletal complications in patients with DM using the Glasgow Ultrasound Enthesitis Scoring System, and to reveal the relationship between clinical and sono-graphic findings. Materials and methods A total of 67 patients (25 men, 42 women) with DM were included in the study. All the diabetic patients were selected if they did not have any symptom of muscu-loskeletal system in the lower extremities. They were divided into four groups. Ultrasonographic assessment was performed according to the Glasgow Ultrasound Enthesitis Scoring System with an Esaote MyLab 5 device equipped with a 5-13 MHz linear transducer. Correlation between diabetes duration and lower extremity enthesopathy scores were evaluated. Results There was a significant correlation between duration of DM and total Glasgow Ultrasound Enthesitis Scoring System scores (p < 0.001). In addition, duration of DM was significantly correlated with enthesophyte scores and erosion scores (both p < 0.001). There was a significant difference among Groups 1 -4 for the mean enthesophyte score and mean erosion score (both, p < 0.001). Conclusion Musculoskeletal ultrasonography is an effective, inexpensive, and useful tool without radiation for evaluating diabetic patients for the early diagnosis of musculoskeletal complications.
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Affiliation(s)
- Sibel Caglar Okur
- Physical Medicine and Rehabilitation Unit, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Pekin Dogan
- Physical Medicine and Rehabilitation Unit, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Murat Mert
- Department of Orthopedics and Traumatology, Yeni Yüzyıl University, Istanbul, Turkey
| | - Ozge Aksu
- Physical Medicine and Rehabilitation Unit, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ozer Burnaz
- Physical Medicine and Rehabilitation Unit, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nil Sayiner Caglar
- Physical Medicine and Rehabilitation Unit, Istanbul Training and Research Hospital, Istanbul, Turkey
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Hussein DA, El-Azizi NO, Abdel Meged AH, Al-Hoseiny SA, Hamada AM, Sabry MH. Ultrasonographic tendon alteration in relation to parathyroid dysfunction in chronic hemodialysis patients. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2015; 8:9-14. [PMID: 25674023 PMCID: PMC4315125 DOI: 10.4137/cmamd.s20887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To find the nature of tendon involvement in chronic kidney disease (CKD) patients on regular hemodialysis (RD), and its relationship to parathyroid hormone (PTH) level using ultrasonography (US). METHOD A total of 50 CKD patients on RD subjected to musculoskeletal examination of knee and ankle, laboratory evaluation, and US of quadriceps tendon and Achilles tendon were involved. RESULTS Ankle joint tenderness was the most frequent sign on examination. US of the Achilles tendons showed tenderness during probing in 44% patients, calcific deposition in 24% patients, abnormal peritendon tissue in 20% patients, and abnormal anteroposterior (A-P) middle and distal one-third thicknesses of the Achilles tendon in 20% and 18% patients, respectively. PTH positively correlated with the duration of dialysis, serum phosphorus level, presence of calcific deposit, and increased thickness of the Achilles tendon. CONCLUSION The most common ultrasonographic finding in CKD patients on RD was Achilles tendon tenderness during probing. PTH level positively correlated with the duration of dialysis, presence of calcific deposit, and increased thickness of Achilles tendon.
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Affiliation(s)
- Dahlia A Hussein
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Noran O El-Azizi
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ali H Abdel Meged
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Sameh A Al-Hoseiny
- Department of Radiology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Abdelhady M Hamada
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Moshira H Sabry
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
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Ozkan F, Bakan B, Fatih Inci M, Kocturk F, Yildirim Cetin G, Yuksel M, Sayarlioglu M. Avaliação de entesopatia em pacientes com fibromialgia por meio do novo índice ultrassonográfico de entesite. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000400004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ozkan F, Cetin GY, Inci MF, Bakan B, Yuksel M, Ekerbicer HC, Sayarlioglu M. Increased enthesopathy in patients with familial Mediterranean fever: evaluation with a new sonographic enthesitis index. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:325-332. [PMID: 23341390 DOI: 10.7863/jum.2013.32.2.325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aim of this study was to determine the frequency of enthesopathy in familial Mediterranean fever by using a newly developed sonographic method, the Madrid Sonographic Enthesitis Index (MASEI). METHODS The study included 50 consecutive patients with familial Mediterranean fever and 57 healthy sex- and age-matched control participants. Six entheseal sites (olecranon tuberosity, superior and inferior poles of the patella, tibial tuberosity, and superior and inferior poles of the calcaneus) on both lower limbs were evaluated. All sonographic findings were identified according to MASEI. Validity was analyzed by receiver operating characteristic curves. P < .05 was considered significant. RESULTS Mean total enthesitis scores ± SD were 7.54 ± 4.99 for patients and 3.63 ± 3.03 for controls (P < .001). No statistically significant correlation was found between the MASEI score and familial Mediterranean fever duration or colchicine treatment duration. There was no difference between the MASEI score and the presence or absence of arthritic involvement among the patients. The area under the receiver operating characteristic curve was 0.74 (95% confidence interval, 0.649-0.839). When analyzed by sex, men with familial Mediterranean fever had significantly higher MASEI scores than women (P < .05). CONCLUSIONS This study showed significant enthesopathy in patients with familial Mediterranean fever. The findings support the hypothesis that familial Mediterranean fever and spondyloarthropathy may have common inflammatory mechanisms and suggest that the MASEI scoring system can be incorporated into clinical protocols for studying patients with familial Mediterranean fever in daily practice.
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Affiliation(s)
- Fuat Ozkan
- Department of Radiology, Medical Faculty, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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Sonographic Evaluation of Subclinical Entheseal Involvement in Patients With Behçet Disease. AJR Am J Roentgenol 2012; 199:W723-9. [DOI: 10.2214/ajr.12.8576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gandjbakhch F, Terslev L, Joshua F, Wakefield RJ, Naredo E, D'Agostino MA. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther 2011; 13:R188. [PMID: 22093457 PMCID: PMC3334637 DOI: 10.1186/ar3516] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 07/06/2011] [Accepted: 11/17/2011] [Indexed: 02/07/2023] Open
Abstract
Introduction An increasing number of studies have applied ultrasound to the evaluation of entheses in spondyloarthritis patients. However, no clear agreement exists on the definition of enthesitis, on the number and choice of entheses to examine and on ultrasound technique, which may all affect the results of the examination. The objectives of this study were to first determine the level of homogeneity in the ultrasound definitions for the principal lesions of enthesitis in the published literature and second, to evaluate the metric properties of ultrasound for detecting enthesitis according to the OMERACT filter. Methods Search was performed in PUBMED and EMBASE. Both grey-scale and Doppler definitions of enthesitis, including describing features of enthesitis, were collected and metrological qualities of studies were assessed. Results After selection, 48 articles were analyzed. The definition of ultrasound enthesitis and elementary features varied among authors. Grey-scale enthesitis was characterized by increasing thickness (94% of studies), hypoechogenicity (83%), enthesophytes (69%), erosions (67%), calcifications (52%), associated bursitis (46%) and cortical irregularities (29%). Only 46% of studies reported the use of Doppler. High discrepancies were observed on frequency, type of probe and Doppler mode used. Face and content validity were the most frequently evaluated criteria (43%) followed by reliability (29%) and responsiveness (19%). Conclusions Ultrasound has evidence to support face, content validity and reliability for the evaluation of enthesitis, though there is a lack of well-reported methodology in most of the studies. Consensus on elementary lesions and standardization of exam is needed to determine the ultrasound definition of enthesitis in grey-scale and in Doppler for future applications.
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Affiliation(s)
- Frédérique Gandjbakhch
- Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, APHP, 83 Boulevard de l’hôpital 75013 Paris, France
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Sonographic subclinical entheseal involvement in dialysis patients. Clin Rheumatol 2011; 30:907-13. [PMID: 21318283 DOI: 10.1007/s10067-011-1703-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 01/15/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
Long-term dialysis treatment can be associated with several musculoskeletal complications. Entheseal involvement in dialysis patients remains rarely studied as its prevalence is underestimated due to its often asymptomatic presentation. The aims of the study were to determine the prevalence of subclinical enthesopathy in haemodialysis and peritoneal dialysis patients at the lower limb level, to investigate the inter-observer reliability of ultrasound assessment and to analyse the influence of biometric and biochemical parameters. Ultrasound examination was conducted at the entheses of the lower limbs level in 33 asymptomatic dialysis patients and 33 healthy adopting the Glasgow Ultrasound Enthesitis Scoring System (GUESS). The inter-observer reliability was calculated in 15 dialysis patients. Ultrasound found at least one sign of enthesopathy in 165 out of 330 (50%) entheses of dialysis patients. In healthy subjects, signs of enthesopathy were present in 54 out of 330 (16.3%) entheses (p < 0.0001). No power Doppler signal was detected in healthy controls, in contrast to four of 330 entheses of dialysis patients. No US signs of soft tissue amyloid deposits were found. The GUESS score was significantly higher in dialysis patients than in controls (p < 0.0001). There was no difference in terms of enthesopathy between haemodialysis and peritoneal dialysis. Dialysis duration resulted to be the most important predictor for enthesopathy (p = 0.0004), followed by patient age (p = 0.02) and body mass index (p = 0.035). Parathormone, calcium, phosphorus, C-reactive protein, cholesterol and triglycerides apparently did not play a relevant role in favour of enthesopathy. The inter-observer reliability showed an excellent agreement between sonographers with different degree of experience. Our results demonstrated a higher prevalence of subclinical enthesopathy in both haemodialysis and peritoneal dialysis patients than in healthy subjects. Follow-up will provide further information with respect to the predictive value of US findings for the development of symptomatic dialysis-related arthropathy.
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