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Explaining Variability in the Prevalence of Achilles Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals. J Orthop Sports Phys Ther 2021; 51:232-252. [PMID: 33779214 DOI: 10.2519/jospt.2021.9970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals. DESIGN Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020. STUDY SELECTION CRITERIA We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions. DATA SYNTHESIS Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity. RESULTS We included 91 studies (10 156 limbs, 5841 participants). The prevalence of Achilles tendon abnormalities on imaging ranged from 0% to 80% per participant. Between-study heterogeneity was high (I2>90%, P<.001), precluding data pooling. Between-study heterogeneity was partly explained by participant mean BMI (slope, 2.8% per 1-unit increase in BMI; 95% confidence interval: 0.57%, 5.03%; P = .015) and participation in physical activity per limb, and mean age of 40 years old or older (P = .022) per participant. CONCLUSION There was substantial variability in the prevalence of Achilles tendon abnormalities on imaging in asymptomatic individuals. Higher prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design. J Orthop Sports Phys Ther 2021;51(5):232-252. Epub 28 Mar 2021. doi:10.2519/jospt.2021.9970.
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Physical Activity and Investigation With Magnetic Resonance Imaging Partly Explain Variability in the Prevalence of Patellar Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals. J Orthop Sports Phys Ther 2021; 51:216-231. [PMID: 33779217 DOI: 10.2519/jospt.2021.10054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the pooled prevalence of, and factors associated with, the presence of patellar tendon abnormalities observed on imaging in people without symptoms. DESIGN Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH We searched Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science from 1980 to August 2020. STUDY SELECTION CRITERIA We included studies that reported the prevalence of asymptomatic patellar tendon abnormalities on imaging. We excluded studies of participants with current tendon pain, a history of tendon pain, or other systemic conditions. DATA SYNTHESIS Stratification and meta-regression of studies based on study-level descriptive statistics (mean age, body mass index, proportion of female participants, physical activity participation, imaging modality) were performed using a random-effects model to account for between-study heterogeneity. Risk of bias was assessed using the modified Newcastle-Ottawa scale. RESULTS Meta-analysis of 64 studies (7125 limbs from 4616 participants) found significant between-study heterogeneity (I2≥90%, P<.01), which precluded a summary prevalence estimate. Heterogeneity was partially explained by studies that included participants who were physically active and studies that assessed tendon abnormalities using magnetic resonance imaging compared to ultrasound (P<.05). Mean age, body mass index, proportion of female participants, and sample size did not explain the remaining heterogeneity. CONCLUSION There was substantial variability in the reported prevalence of asymptomatic patellar tendon abnormalities. A clear and valid method is needed to assess and report the presence of patellar tendon abnormalities to increase research capacity and establish the clinical value of imaging the patellar tendon. J Orthop Sports Phys Ther 2021;51(5):216-231. Epub 28 Mar 2021. doi:10.2519/jospt.2021.10054.
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Wang M, Li Y, Cao Y, Lu X, Liu Y, Zhao J, Zhang W, Li C. Mandibular involvement in SAPHO syndrome: a retrospective study. Orphanet J Rare Dis 2020; 15:312. [PMID: 33153463 PMCID: PMC7643311 DOI: 10.1186/s13023-020-01589-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mandible osteomyelitis can occur in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, a rare chronic inflammatory disease; however, few studies have explored its characteristics and management. METHODS We reviewed the medical records of consecutive SAPHO patients with mandible involvement diagnosed in Peking Union Medical College Hospital from September 2014 to July 2019. Demographic, clinical, laboratory, and imaging data were collected at baseline. Prescription data and follow-up magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) images were collected from the hospital information system. An electronic questionnaire was distributed to all patients to obtain their latest symptoms. RESULTS A total of 26 SAPHO patients with mandibular involvement were involved, all of whom responded to the questionnaire (38.5% male; median age, 28 years; median follow-up duration, 2.1 years). Ten patients (38.5%) had undergone an oral procedure 1 month before the onset of mandibular symptoms. All 14 of the patients who underwent a surgical intervention relapsed within a median duration of 2 months (range 0.25-4.0 months), and 24 patients (92.3%) achieved improvement with conservative treatment. Following bisphosphonate treatment, remission of bone marrow oedema and osteolysis was observed on MRI and CBCT, and 5 patients receiving bisphosphonates with follow-up CBCT after remission did not relapse in 5.4 months (mean 6.0, range 3.2-9.9 months). CONCLUSION Mandibular involvement of SAPHO syndrome predominantly occurs in young women. Dental procedures are a possible risk factor. Conservative treatment, especially intravenous bisphosphonates, can lead to oral improvement.
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Affiliation(s)
- Mu Wang
- Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yueting Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yihan Cao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinyu Lu
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yuchen Liu
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Wen Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Chen Li
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Rodríguez-Caminero S, Queiro R. Ultrasound subclinical musculoskeletal findings in inflammatory bowel disease: diagnostic value of positive Doppler signal. Rheumatology (Oxford) 2020; 59:3571-3572. [PMID: 32699882 DOI: 10.1093/rheumatology/keaa320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023] Open
Affiliation(s)
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
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Seven S, Pedersen SJ, Østergaard M, Felbo SK, Sørensen IJ, Døhn UM, Terslev L. Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis-Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy. Front Med (Lausanne) 2020; 7:341. [PMID: 32766263 PMCID: PMC7381133 DOI: 10.3389/fmed.2020.00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives: To investigate the anatomical distribution, morphological abnormalities and response to adalimumab therapy of ultrasound(US)-detected peripheral enthesitis in patients with axial spondyloarthritis (SpA). Methods: In a randomized, placebo-controlled, double-blinded, investigator-initiated trial (NCT01029847), patients with axial SpA according to the Assessment of Spondyloarthritis International Society criteria were randomized to subcutaneous adalimumab 40 mg every other week or placebo from baseline to week 6. From week 6 to 24, all patients received adalimumab 40 mg every other week. Of 49 patients enrolled, 21 patients participated in our observational US sub-study. US assessment applying the OMERACT US definitions for enthesitis of 10 peripheral entheseal regions of the upper and lower extremities and clinical examination were performed at baseline, weeks 6 and 24. US was performed by one experienced investigator. Hypo-echogenicity, increased thickness and Doppler activity of the enthesis were considered signs of active inflammation, whereas insertional bone erosions, intratendinous calcifications, and enthesophytes were regarded as signs of structural lesions. Results: Enthesitis on US was mostly present in the lower limbs, especially in the Achilles tendon (81%), the quadriceps tendon (62%), and the greater femoral trochanter (52%). Structural lesions were predominant (38 vs. 12% of examined entheses with inflammatory changes), particularly in the entheses of the lower limbs, and exhibited no change during treatment. Conclusion: US-detected structural lesions were common while inflammatory lesions were relatively rare in patients initiating adalimumab due to axial SpA. Structural lesions did not appear to change during 24 weeks follow-up, suggesting that these lesions may not be helpful outcome measures in short-term clinical trials.
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Affiliation(s)
- Sengul Seven
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sara Kamp Felbo
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Inge Juul Sørensen
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gao S, Deng X, Zhang L, Song L. The comparison analysis of clinical and radiological features in SAPHO syndrome. Clin Rheumatol 2020; 40:349-357. [PMID: 32504191 DOI: 10.1007/s10067-020-05187-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim was to comparatively assess the clinical and imaging features in patients with SAPHO syndrome. METHODS The clinical data, laboratory results, imaging data of forty-six SAPHO patients were reviewed and the SAPHO patients were divided into spinal involvement group and non-spinal involvement group. Fifty patients with ankylosing spondylitis were recruited as control group. The clinical and radiological features of them were analyzed and compared. RESULTS Thirty-four of 46 (73.9%) of all the SAPHO patients had spinal involvement. The lesions exhibited as abnormal hyper-intensity signal in vertebral bodies, vertebral body erosion or collapse, bone marrow edema, endplate inflammation, spondyldiscitis, paravertebral ossification, and facet joint involvement. Compared with patients in non-spinal involvement group, the age at disease onset was older (P = 0.033), the disease duration was longer (P = 0.048), and CRP level was elevated (P = 0.047) in patients in spinal involvement group. Compared with patients with ankylosing spondylitis, SAPHO patients were more likely to have cervical vertebra involvement (P = 0.024), endplate inflammation (P = 0.019), and spondyldiscitis (P = 0.001), but less multiple vertebral body and facet joint involvement (P = 0.002). Patients regularly received DMARDS or biologics treatment had symptoms relieved and lesions turned into chronic stage or better than before. CONCLUSIONS A total of 73.9% of the SAPHO patients had spinal involvement and the involvement could affect any part of the spine. Cervical vertebral involvement, endplate inflammation, and sponlypodiscitis were more common in SAPHO than in patients with ankylosing spondylitis. In SAPHO patients with spinal involvement, the disease duration was longer and the inflammatory reaction was more intensive. DMARDs and biologics may help to prevent the disease progress. KEY POINTS • To the best of our knowledge, this paper is the first one to comparatively study the clinical and radiological features of SAPHO syndrome, especially the characteristics of spinal involvement.
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Affiliation(s)
- Shuang Gao
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - XiaoLi Deng
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China.
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
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Liu G, Lu T, Li Y, Liu Y, Ji X, Jia W, Sun M, Luo Y. Exosomal proteome from the serum, bone marrow, and palm and toe pustular skin tissues of a single patient with SAPHO syndrome. J Proteomics 2020; 216:103673. [PMID: 32001333 DOI: 10.1016/j.jprot.2020.103673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 12/24/2022]
Abstract
Exosome proteomic analysis may reveal differentially abundant proteins that are of significance for clarifying the pathogenesis of SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) syndrome. Exosomes were isolated from the serum, bone marrow and skin tissue of the palm and toe pustular areas in a unique patient with SAPHO syndrome. The exosomes were not different from those of healthy subjects in size (114.1 ± 73.7 nm) or morphology. Label-free exosome proteomic analysis identified 198 more abundant proteins and 183 less abundant compared with those of healthy subjects. Gene ontology enrichment analysis revealed that these proteins were involved in binding with a variety of biological molecules and participated in biological processes related to autoimmunity or inflammation. A total of 243 KEGG (Kyoto Encyclopedia of Gene and Genomes) pathways were enriched, of which 43 were related to immune function. It was speculated that five differentially abundant proteins, Mitogen-activated protein kinase 1 (MAPK1/MK01), Tyrosine protein kinase (SYK), Integrin beta-3 (ITB3), Serine/threonine-protein phosphatase 2a catalytic subunit alpha isoform (PP2AA) and Serine/threonine-protein phosphatase 2a 65 kDa regulatory subunit A beta isoform (2AAB), associated with multiple KEGG pathways, forms an interaction network that may be involved in the occurrence, development and prognosis of SAPHO syndrome. SIGNIFICANCE: Exosomes of SAPHO syndrome patient were not significantly different from those of healthy subjects in size and morphology. Label-free proteomic analysis of exosomal proteins in patient with SAPHO syndrome speculated 5 proteins MAPK1, SYK, ITB3, PP2AA and 2AAB, which may be involved in the occurrence, development and prognosis of SAPHO syndrome by binding with other biological molecules. It is speculated for the first time that proteins Histone H2A type 1-J and Histone H4 were related to SAPHO syndrome. Clinic relevance. Exosome proteomics can suggest novel pathological data in patients with SAPHO.
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Affiliation(s)
- Guomin Liu
- Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China; Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Tiancheng Lu
- Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China; Life Sciences College, Jilin Agricultural University, Changchun, Jilin 130118, China.
| | - Yalong Li
- Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China; Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Yun Liu
- Department of Stomatology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China; Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China.
| | - Xuan Ji
- Department of Stomatology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China; Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China.
| | - Wenyuan Jia
- Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China; Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Maolei Sun
- Department of Stomatology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China; Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China.
| | - Yungang Luo
- Department of Stomatology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China; Jilin Provincial Changbai Mountain Anti-tumor Medicine Engineering Center, Changchun, Jilin, China.
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Abstract
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome was first described as chronic recurrent multifocal osteomyelitis. Because of its rarity, a thorough description of its clinical manifestations is lacking. Herein, we describe the clinical manifestations and imaging features, especially the enthesopathy in bilateral Achilles tendons, of a middle-aged Asian woman with SAPHO syndrome, who improved after diclofenac treatment.
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Affiliation(s)
- Chin-Fang Su
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chuan Shen
- Division of Rheumatology, Tao-Yuan General Hospital, Ministry of Health & Welfare, Tao-Yuan, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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Asano T, Furuya MY, Fujita Y, Matsuoka N, Sato S, Kobayashi H, Watanabe H, Honda A, Migita K. Diagnostic value of ultrasonography in synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome: A case report. Medicine (Baltimore) 2018; 97:e12725. [PMID: 30313072 PMCID: PMC6203473 DOI: 10.1097/md.0000000000012725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is a rare condition that affects the skin, bones, and joints. Diagnosis of SAPHO syndrome is established based on clinical manifestations and imaging features on radiography or magnetic resonance imaging. PATIENT CONCERNS We report a 44-year-old male with a 20-year history of pustulosis who presented with pain in the lower extremities. Plain radiography demonstrated hyperostosis with subperiosteal erosions in the right tibia. Magnetic resonance imaging and computed tomography showed inflammatory accumulation, whereas musculoskeletal ultrasonography clearly depicted a periosteal reaction, osteitis, and enthesitis with abnormal blood flow in the surface of the right tibia. DIAGNOSES A diagnosis of SAPHO syndrome was made. INTERVENTIONS The patient was treated with combination therapy comprising prednisolone, methotrexate, and infliximab, which resulted in clinical improvement. OUTCOMES The elevated levels of C-reactive protein and matrix metalloproteinase-3 normalized, and the abnormal ultrasonographic findings disappeared. LESSONS The present case report demonstrates that multiple imaging modalities are important for the definitive diagnosis of SAPHO syndrome. Ultrasonography might be a useful tool for evaluating local musculoskeletal inflammation in patients with SAPHO syndrome.
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Affiliation(s)
| | | | | | | | | | | | | | - Aki Honda
- Department of Dermatology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Performance of Two Screening Questionnaires for Inflammatory Arthritis in Patients with Inflammatory Bowel Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8618703. [PMID: 29854801 PMCID: PMC5964541 DOI: 10.1155/2018/8618703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/22/2018] [Accepted: 04/01/2018] [Indexed: 01/21/2023]
Abstract
Musculoskeletal symptoms are the most common extraintestinal manifestations of inflammatory bowel disease (IBD). An essential step in the management of these patients is to establish referral algorithms through the use of appropriate screening tools. Our objective was to evaluate the performance of two simple questionnaires to detect inflammatory arthritis (IA) in patients with IBD. Two questionnaires, one for detecting axial IA and the other for peripheral IA, were tested among 112 IBD unselected consecutive patients of both sexes, aged 18–45 years. The study period was from January to December 2016. Each questionnaire was composed of three simple questions. If the patient answered affirmatively at least to two of the three questions, the questionnaire was considered positive. Clinical diagnosis of IA based on an expert's opinion was the reference gold standard. To obtain a weighted value of sensitivity and specificity, likelihood ratio (LR) values were calculated. Twenty-seven percent of the patients were considered positive responders to the axial questionnaire while 32% were considered positive responders to the peripheral questionnaire. Twenty-four patients (21.4%) were diagnosed with axial IA, whereas 26% had peripheral IA. The axial questionnaire yielded a sensitivity of 87.5% (67.6–97.3), specificity of 89.8% (81.5–92.2) and LR+ of 8.6 (4.5–16.2). For the peripheral questionnaire, these values were 82.8% (64.2–94.2), 87.4% (79–93.3), and 6.6 (3.8–11.4), respectively. Both questionnaires showed an adequate screening capacity for IA in patients with IBD. Their specificity, together with their simplicity, can make them suitable detection tools in gastroenterology and general medicine consultations.
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Schaub S, Sirkis HM, Kay J. Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Rheum Dis Clin North Am 2017; 42:695-710. [PMID: 27742022 DOI: 10.1016/j.rdc.2016.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.
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Affiliation(s)
- Steven Schaub
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Hartley M Sirkis
- Division of Musculoskeletal Imaging, Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
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Wink F, Bruyn GA, Maas F, Griep EN, van der Veer E, Bootsma H, Brouwer E, Arends S, Spoorenberg A. Ultrasound Evaluation of the Entheses in Daily Clinical Practice during Tumor Necrosis Factor-α Blocking Therapy in Patients with Ankylosing Spondylitis. J Rheumatol 2017; 44:587-593. [PMID: 28298566 DOI: 10.3899/jrheum.160584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess structural and inflammatory ultrasound (US) lesions of entheses in ankylosing spondylitis (AS) patients with active disease and to evaluate inflammatory lesions after 6 months of tumor necrosis factor (TNF-α) blocking therapy, in daily clinical practice. METHODS Consecutive patients with AS were clinically evaluated and underwent US examination of 9 bilateral entheses before and after 6 months of TNF-α blocking therapy. US examination included the following as inflammatory lesions: bone erosions/cortical irregularities, enthesophytes, calcifications as structural lesions; adjacent bursitis, effusion, increased tendon hypoechogenicity or thickness; and positive power Doppler (PD) signal. RESULTS At baseline, 105 (95%) of 111 included patients showed US abnormalities. Structural lesions were seen in 74 patients (67%) and inflammatory lesions in 88 (79%). Enthesophytes and positive PD signal were the most prevalent structural and inflammatory lesions, respectively. Most lesions were found at the lower extremities. Additionally, inflammatory lesions occurred at the lateral epicondyle of the elbow. Patients with structural lesions at baseline were significantly older, had longer disease duration, higher modified Stoke AS Spine score, and higher C-reactive protein. Individually, there was a great diversity in changes of inflammatory entheseal lesions during treatment, but on the group level no significant decrease was found. CONCLUSION This prospective observational cohort study in daily clinical practice shows a high prevalence of structural and inflammatory US lesions in AS patients with longstanding and active disease. Positive PD signal was the most common inflammatory feature. No significant change in inflammatory US lesions was found after 6 months of TNF-α blocking therapy.
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Affiliation(s)
- Fréke Wink
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands. .,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden.
| | - George A Bruyn
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Fiona Maas
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Ed N Griep
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Eveline van der Veer
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Hendrika Bootsma
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Elisabeth Brouwer
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Suzanne Arends
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
| | - Anneke Spoorenberg
- From the Department of Rheumatology and Clinical Immunology, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.,F. Wink, MD, Department of Rheumatology, Medical Center Leeuwarden; G.A. Bruyn, MD, Department of Rheumatology, MC Groep; F. Maas, MSc, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.N. Griep, MD, PhD, Antonius Ziekenhuis Sneek; E. van der Veer, PhD, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E. Brouwer, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, and Department of Rheumatology, Medical Center Leeuwarden; A. Spoorenberg, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Department of Rheumatology, Medical Center Leeuwarden
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Xu W, Li C, Zhao X, Lu J, Li L, Wu N, Zuo Y, Jing H, Dong Z, Zhang W, Zhang W. Whole-spine Computed Tomography Findings in SAPHO Syndrome. J Rheumatol 2017; 44:648-654. [PMID: 28250144 DOI: 10.3899/jrheum.161075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We evaluated the whole-spine computed tomography (CT) findings in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome to improve our understanding of this rare disease. METHODS Whole-spine CT images obtained in 69 patients with SAPHO were reviewed. For each individual, a total of 25 vertebrae were evaluated for the distribution of affected vertebrae, CT manifestations of vertebral lesions, symmetry and location of distribution of the lesions on vertebrae, involvement pattern, and narrowing of adjacent intervertebral disc space. Paravertebral ligamentous ossifications, apophyseal joint disorders, and costovertebral joint disorders were also evaluated. RESULTS All the 69 patients with SAPHO exhibited abnormalities on whole-spine CT. Sixty-four had vertebral lesions, 52 had paravertebral ossifications, and 47 had both. The vertebral lesions were observed in 441 vertebrae, with a predilection for thoracic spine. The lesions exhibited a mixture of cortical erosion, reactive osteosclerosis of surrounding cancellous bone, and syndesmophyte. They may be confined to the vertebral corner (65.1%) or be extensive, involving the endplate (34.9%). Corner lesions could start in any part of the epiphyseal ring. The lesions were asymmetrically distributed. The affected vertebrae were more consecutively involved in a "kissing" appearance (78.2%). Intervertebral disc spaces were usually normal or mildly narrowed. There were 320 foci of paravertebral ossifications observed, with a predilection for the supraspinous ligament. Paravertebral ossifications were delicate and segmental. Ossifications throughout annulus fibrosis and apophyseal joint were not observed. CONCLUSION Our investigation of the distributional, morphological features and the involvement pattern of spinal lesions in patients with SAPHO demonstrated distinct CT characteristics.
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Affiliation(s)
- Wenrui Xu
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Chen Li
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Xue Zhao
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Jie Lu
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Li Li
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Nan Wu
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Yuzhi Zuo
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Hongli Jing
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Zhenhua Dong
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Wen Zhang
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China.,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
| | - Weihong Zhang
- From the Department of Radiology, the Department of Traditional Chinese Medicine, the Department of Dermatology, the Department of Orthopedics, the Department of Nuclear Medicine, and the Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Radiology, Beijing Huairou Hospital, Beijing, China. .,W. Xu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; C. Li, Attending Physician, MD, PhD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; X. Zhao, Resident, MD, Department of Radiology, Beijing Huairou Hospital; J. Lu, Resident, MD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; L. Li, Associate Professor, MD, PhD, Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; N. Wu, Attending Physician, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Y. Zuo, Resident, MD, PhD, Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; H. Jing, Associate Professor, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Z. Dong, Professor, MD, Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Professor, MD, PhD, Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; W. Zhang, Associate Professor, MD, PhD, Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences.
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14
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Zhang H, Liang J, Qiu J, Wang F, Sun L. Ultrasonographic evaluation of enthesitis in patients with ankylosing spondylitis. J Biomed Res 2017; 31:162-169. [PMID: 28808198 PMCID: PMC5445219 DOI: 10.7555/jbr.31.20160088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The aim of this study was to assess sensitivity and responsiveness of power Doppler ultrasound (PDUS) in detecting enthesitis for ankylosing spondylitis (AS) patients compared to clinical examinations. Twenty AS patients initiating etanerceptunderwent clinical and PDUS examinations of six bilateral entheseal sites at baseline and after 1, 2 and 3 months of treatment. Clinical and PDUS examinations identified at least one entheseal lesion in nine (45%) and 19 (95%) patients, respectively. Furthermore, of 240 entheseal sites examined in these 20 patients, PDUS detected 123 entheseal lesions (51.3% of sites), compared with only 47 entheseal lesions (19.6%) detected by clinical examination (P<0.05). The entheseal lesions found on PDUS were most commonly identified by calcification (33.3%), tendon edema (29.2%), abnormal blood flow (25.8%), a thickened tendon (22.1%), cortical irregularity (12.9%), bony erosions (9.6%) and bursitis at the tendon insertion to the bone cortex (7.1%). Improvements in clinical symptoms and laboratory parameters, and significant decreases in PDUS scores were observed following treatment with etanercept. Improvements in PDUS scores continued during follow-up in patients who entered remission following treatment. In conclusion, PDUS improves detection of structural and inflammatory abnormalities of the enthesis in AS compared to physical examination. In addition, PDUS may be useful inascertaining medications.
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Affiliation(s)
- Huayong Zhang
- Department of Rheumatologyand Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Jun Liang
- Departments of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Junlan Qiu
- Ultrasound Intervention, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Fan Wang
- Departments of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Lingyun Sun
- Department of Rheumatologyand Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
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15
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Umeda M, Kawashiri SY, Nishino A, Koga T, Ichinose K, Michitsuji T, Shimizu T, Fukui S, Nakashima Y, Hirai Y, Iwamoto N, Aramaki T, Tamai M, Nakamura H, Origuchi T, Ueki Y, Kawakami A. Synovitis of sternoclavicular and peripheral joints can be detected by ultrasound in patients with SAPHO syndrome. Mod Rheumatol 2016; 27:881-885. [DOI: 10.1080/14397595.2016.1259971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan,
| | - Shin-ya Kawashiri
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
- Department of Community Medicine, and
| | - Ayako Nishino
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Toru Michitsuji
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Shoichi Fukui
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Yoshikazu Nakashima
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Yasuko Hirai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | | | - Mami Tamai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
| | - Tomoki Origuchi
- Department Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan,
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan,
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16
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Zimmermann P, Curtis N. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome - A challenging diagnosis not to be missed. J Infect 2016; 72 Suppl:S106-14. [PMID: 27263075 DOI: 10.1016/j.jinf.2016.04.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SAPHO syndrome manifests as chronic inflammation of bones and joints, which may or may not be accompanied by skin changes. The term SAPHO is an acronym that stands for synovitis, acne, pustulosis (usually palmoplantar), hyperostosis and osteitis. The bones most commonly affected are those in the anterior chest wall (mainly the sternum, clavicles and sternocostoclavicular joints), the vertebrae and the sacroiliac joints, but peripheral and flat bones may also be involved, especially in children. There are no validated diagnostic criteria for SAPHO, and diagnosis is based on clinical and radiological findings. One of the main challenges in diagnosis is that the clinical features may occur many years apart. Additionally, patients may not develop all manifestations. Delayed diagnosis, as a result of a lack of awareness of SAPHO, can lead to patients suffering ongoing pain and disfiguring skin manifestations. One theory is that Propionibacterium acnes (isolated from bone biopsies in many SAPHO patients) triggers an auto-immune mediated chronic inflammation in genetically predisposed individuals. Treatment involves the use of nonsteroidal anti-inflammatory drugs, intra-articular steroids, bisphosphonates and biologicals. The course of SAPHO is often prolonged but, despite the challenges in diagnosis and treatment, the long-term prognosis is good.
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Affiliation(s)
- Petra Zimmermann
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology Research Group, Murdoch Children's Research Institute, Parkville, Australia.
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17
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Slobodin G, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, Odeh M. Entheseal involvement in systemic disorders. Clin Rheumatol 2015; 34:2001-10. [PMID: 26354427 DOI: 10.1007/s10067-015-3068-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 08/30/2015] [Indexed: 12/11/2022]
Abstract
The objective of this study is to review the data on entheseal involvement in systemic disorders. A Pubmed search utilizing the indexing terms "enthesis" and "enthesitis" was conducted and the data pertinent to the aim of the review was extracted and organized in accordance with the preplanned structure of the manuscript. A number of cadaver-based studies, as well as studies using ultrasonography and magnetic resonance imaging, have detailed new distinct aspects of enthesis physiology and pathology in a variety of rheumatic and non-rheumatic systemic disorders. Major progress has been done in characterization of separate components of the enthesis organ, imaging of entheses, elaboration of the role and features of entheseal disease in spondyloarthropathies, juvenile idiopathic arthritis, osteoarthritis, familial Mediterranean fever, hyperuricemia, and other systemic conditions. The knowledge acquired and summarized herein shows that entheses can be affected in various ways in variety of medical disorders with different pathogenesis. Better understanding of the risk factors, mechanisms and natural history of enthesopathies is warranted. The current progress in the understanding of entheseal involvement in systemic disorders represents just the first step in resolving the entheses-related enigmas.
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Affiliation(s)
- Gleb Slobodin
- Internal Medicine A, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Doron Rimar
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Majed Odeh
- Internal Medicine A, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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18
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Abstract
The SAPHO syndrome, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a rare disease which affects bones, joints and the skin. The main osteoarticular features are hyperostosis and osteitis. Osteoarticular symptoms predominantly occur on the anterior chest wall but the spine and the peripheral skeleton can also be involved. The most important skin affections are palmoplantar pustulosis and severe acne. The etiology of this syndrome remains unclear but infectious, immunological and genetic factors are involved. The diagnostic features of SAPHO syndrome are clinical and radiological. The most important diagnostic procedure is Tc-99 m bone scintigraphy but conventional x-rays as well as computed tomography (CT) and magnetic resonance imaging (MRI) can also contribute to the final diagnosis. Bone histology and positron emission tomography CT (PET-CT) may help to differentiate SAPHO syndrome from malignancies and infectious osteomyelitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of treatment. The results obtained using antibiotics and disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine and methotrexate are inconsistent. Bisphosphonates and anti-tumor necrosis factor (anti-TNF) drugs have shown promising results in small studies but further research is still necessary.
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19
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Mérot O, Guillot P, Maugars Y, Le Goff B. Three-dimensional versus two-dimensional ultrasonographic assessment of peripheral enthesitis in spondylarthritis. Clin Rheumatol 2013; 33:131-5. [PMID: 24202615 DOI: 10.1007/s10067-013-2424-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/23/2013] [Accepted: 10/21/2013] [Indexed: 12/20/2022]
Abstract
To compare the intra- and interobserver reliability of three-dimensional (3D) volumetric versus conventional two-dimensional (2D) power Doppler ultrasonography (US) in the assessment of peripheral enthesitis in spondylarthritis (SpA). Sixteen patients with SpA according to ASAS criteria were included. Two rheumatologists (one experimented in musculoskeletal US (sonographer 1) and one beginner (sonographer 2)) performed independently a 2D US scoring of the enthesis using the Madrid Sonographic Enthesis Index score followed by a 3D acquisition of the same entheseal sites. The reading of the 3D acquisition was performed a minimum of 1 week apart. Intraobserver reliability was evaluated by a second reading of the same images. The duration of 2D US scanning, 3D US acquisition and reading was recorded. Intraclass correlation coefficients (ICCs) were used for the reliability analysis. Intraobserver reproducibility was good to excellent for 2D US and good for 3D US (ICC (95 %CI) 2D US 0.776 (0.471-0.916) and 0.96 (0.892-0.986) and ICC (95 %CI) 3D US 0.796 (0.498-0.921) and 0.703 (0.325-0.886) for sonographer 1 and 2, respectively). Interobserver reliability was slightly better for 3D US than for 2D US (ICC (95 %CI) 0.776 (0.471-0.916) for 3D US versus 0.641 (0.221-0.859) for 2D US). The mean time (±SD) for 2D US scanning was 23 min (±4) whereas the mean time for 3D US volume acquisition and reading was 16.5 min (±2.6) (p < 0.001). 3D US showed good intra- and interobserver reliability in the assessment of enthesitis in SpA and shortened the needed time for scanning. It can be performed by a nonexperienced examiner without loss of reliability.
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Affiliation(s)
- Oriane Mérot
- Rheumatology Unit, Hôtel-Dieu, Nantes University Hospital, 1 Place Alexis Ricordeau, 44095, Nantes, France
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20
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Abstract
SAPHO syndrome is a disorder characterized by Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis. As the osteoarticular and skin manifestations often do not occur simultaneously and there are no validated diagnostic criteria, the diagnosis can be difficult. Clinical and imaging investigation is necessary to establish the many differential diagnoses of SAPHO syndrome. The etiopathogenesis involves infectious (probably Propionibacterium acnes), immunologic, and genetic factors. Treatment is based on information gathered from case reports and small series, and is related to specific skin or articular symptoms.
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Affiliation(s)
- Sueli Carneiro
- State University of Rio de Janeiro - Rua Farme de Amoedo 140/601, Ipanema, Rio de Janeiro 22420-020, Brazil
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