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Enrique CP, María SA, Gustavo RS, Igor R, Magali CM, Diana PO, Sofia AC, Juliana MM, Camilo SJ, Camilo RJ, Mesa C, Marlon P, Sebastián SCJ, Luis F GC, Cesar PT, Humberto CM, Pedro SM, John L. Assessment of enthesopathy in conventional pelvis radiography: Another tool for spondyloarthritis diagnosis beyond sacroiliitis. Semin Arthritis Rheum 2024; 67:152435. [PMID: 38642418 DOI: 10.1016/j.semarthrit.2024.152435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION/OBJECTIVES Enthesitis is a cardinal feature of spondylarthritis (SpA), and the pelvis is a common site of enthesitis. This study aimed to establish the association between pelvic enthesis involvement on pelvic X-ray and SpA diagnosis through a radiographic enthesis index (REI) and to assess the reliability and accuracy of this REI. MATERIALS AND METHODS The participants were SpA patients and a control group composed of patients with chronic lumbar pain without SpA. Three blinded observers assessed each pelvic radiography three times. Three zones were used: Zone I (ZI), the iliopubic ramus; Zone II (ZII), the pubic symphysis, and Zone III (ZIII), the ischiopubic ramus. A grading system was created from 0 to 3 [Grade 0, normal; Grade 1, minimal changes (subcortical bone demineralization and/or periosteal wishkering, seen as radiolucency and trabeculation of the cortical bone upon tendon insertion); Grade 2, destructive changes (Grade 1 findings and erosions at the enthesis site); and Grade 3, findings of Grade 2 plus >2 mm whiskering out of the cortical bone) for the REI. The sum of the results of the three zones was called the total REI. For statistical analysis, we used the weighted kappa statistic adjusted for prevalence and bias using Gwet's agreement coefficient. RESULTS We enrolled 161 patients, 111 of them with SpA (39.6 % with axial SpA and 47.7 % with peripheral SpA) and 50 without SpA. In the SpA group, 36.7 % and 25.7 % had REI Grades 2 and 3 in ZIII, respectively, while only 6 % of the controls had these grades. For ZI, the frequency of Grades 1 to 3 was 42.3 % in the SpA group (8.1 %, 14.4 %, and 19.8 %, respectively), compared to only 2 % in the controls. ZII was unaffected in most of the patients with SpA (82.9 %) and in the controls (98 %). In the control group, Grade 0 was the most common REI grade in all three zones. The agreement was almost perfect for each zone and between the independent readers. The ROC-curve analysis showed that the highest performance areas were the total REI, ZIII, and ZI. Most (75 %) of the SpA patients without sacroiliitis on X-ray were REI-positive. The sensitivity of the REI for SpA diagnosis was 82 %, while the sensitivity of sacroiliitis on X-ray was 38.7 %. CONCLUSIONS The assessment of pelvic enthesis using the REI on pelvic radiography may be useful for SpA diagnosis. Total REI, ZIII, and ZI had the highest accuracy and almost perfect reliability. The REI is especially helpful in patients without sacroiliitis on imaging.
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Affiliation(s)
| | - Santos Ana María
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rodríguez-Salas Gustavo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rueda Igor
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia; Bioscience programme, faculty of Medicine and Engineering, Universidad de La Sabana, Chía, Colombia
| | | | - Padilla-Ortiz Diana
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia
| | - Arias-Correal Sofia
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Mantilla Marta Juliana
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Santacruz Juan Camilo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Rueda Juan Camilo
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia; Bioscience programme, faculty of Medicine and Engineering, Universidad de La Sabana, Chía, Colombia
| | - Cristian Mesa
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia
| | - Porras Marlon
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia
| | | | - Giraldo-Cadavid Luis F
- Universidad de La Sabana - Interventional Pulmonology, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Pacheco-Tena Cesar
- PABIOM Laboratory, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, 31125 Chihuahua, Mexico
| | - Cardiel Mario Humberto
- Hospital General "Dr. Miguel Silva", Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, McMaster University, Universidad Michoacana de San Nicolas de Hidalgo Instituto de Física y Matemáticas
| | | | - Londono John
- Spondyloarthritis Study group (GESPA), Universidad de La Sabana, Chía, Colombia; Department of rheumatology, Hospital Militar Central, Bogotá D.C., Colombia.
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Tortosa-Cabañas M, Tejero-Carmona ME, García-Montes N, Guillén-Astete CA. Ultrasound Changes in the Enthesis and Peri-enthesis Area of the Patellar and Achilles Tendons in Response to Physical Exercise: Comparison Between Healthy Subjects and Patients with Spondyloarthritis in Clinical Remission. Acad Radiol 2024:S1076-6332(24)00230-7. [PMID: 38796403 DOI: 10.1016/j.acra.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/09/2024] [Accepted: 04/13/2024] [Indexed: 05/28/2024]
Abstract
RATIONALE AND OBJECTIVES The goal of achieving clinical remission in patients with spondyloarthritis does not necessarily include the resolution of entheseal inflammation from a histological perspective. However, enthesis not clinically inflamed, under mechanical stress, may behave differently from healthy subjects considering the physiopathology of SpA. Our goal was to determine whether ultrasound changes in entheses differ between SpA patients in clinical remission and healthy subjects. METHODS SpA patients in clinical remission and matched healthy controls were recruited. At baseline, the following variables were measured on the dominant side by ultrasound: thickness of the distal patellar enthesis (hDP), the deep infrapatellar bursa (hDIB), the Achilles enthesis (hA), the preachilleal bursa (hPAB), effusion in the preachileal bursa (hePAB), and the presence of power Doppler signal in both enthesis. All measurements except hDP and hA were collected again after exercise (post-stress ultrasound). RESULTS 30 patients and 30 controls were enrolled. In all subjects, hDIB, hPAB, and the preachileal bursa occupancy index increased significantly after the exercise. The increase was significantly greater in patients for all variables. At baseline, in patients, hyperemia was detected in one patellar tendon (3.3%) and in two Achilles tendons (6.7%). After exercise, the number of tendons with hyperemia increased to 11/30 (36.7%) and 12/30 (40%), respectively. Among controls, there was no detectable basal hyperemia, but after exercise, it was detected in 1/30 patellar tendons (3.3%) and 2/30 Achilles tendons (6.7%). CONCLUSION Exercise triggers a greater effusive and hyperemic synovial response in patients in remission than in healthy controls. These findings suggest that the definition of remission should also include an assessment of the synovial response to mechanical stress. HIGHLIGHTS
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Affiliation(s)
| | | | - Nuria García-Montes
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain
| | - Carlos Antonio Guillén-Astete
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain; Universidad Europea de Madrid, Dept. of Medicine, Fac. of Biomedical and Health Sciences, Spain.
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Bhosale YH, Patnaik KS. Bio-medical imaging (X-ray, CT, ultrasound, ECG), genome sequences applications of deep neural network and machine learning in diagnosis, detection, classification, and segmentation of COVID-19: a Meta-analysis & systematic review. MULTIMEDIA TOOLS AND APPLICATIONS 2023:1-54. [PMID: 37362676 PMCID: PMC10015538 DOI: 10.1007/s11042-023-15029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 06/28/2023]
Abstract
This review investigates how Deep Machine Learning (DML) has dealt with the Covid-19 epidemic and provides recommendations for future Covid-19 research. Despite the fact that vaccines for this epidemic have been developed, DL methods have proven to be a valuable asset in radiologists' arsenals for the automated assessment of Covid-19. This detailed review debates the techniques and applications developed for Covid-19 findings using DL systems. It also provides insights into notable datasets used to train neural networks, data partitioning, and various performance measurement metrics. The PRISMA taxonomy has been formed based on pretrained(45 systems) and hybrid/custom(17 systems) models with radiography modalities. A total of 62 systems with respect to X-ray(32), CT(19), ultrasound(7), ECG(2), and genome sequence(2) based modalities as taxonomy are selected from the studied articles. We originate by valuing the present phase of DL and conclude with significant limitations. The restrictions contain incomprehensibility, simplification measures, learning from incomplete labeled data, and data secrecy. Moreover, DML can be utilized to detect and classify Covid-19 from other COPD illnesses. The proposed literature review has found many DL-based systems to fight against Covid19. We expect this article will assist in speeding up the procedure of DL for Covid-19 researchers, including medical, radiology technicians, and data engineers.
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Affiliation(s)
- Yogesh H. Bhosale
- Computer Science and Engineering Department, Birla Institute of Technology, Mesra, Ranchi, India
| | - K. Sridhar Patnaik
- Computer Science and Engineering Department, Birla Institute of Technology, Mesra, Ranchi, India
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The identification of association between ultrasonographic enthesitis and the ASAS Health Index in patients with axial spondyloarthritis. Rheumatol Int 2023; 43:99-107. [PMID: 35987923 DOI: 10.1007/s00296-022-05188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
This study aimed to evaluate association between the entheseal abnormalities in ultrasound and the Assessment of Spondyloarthritis International Society Health Index (ASAS HI) in patients with axial spondyloarthritis (axSpA). Seventy-four patients with axSpA were enrolled in this study. Ultrasonographic evaluation of entheses was performed by a blinded rheumatologist with the Madrid Sonographic Enthesitis Index (MASEI). The MASEI total score and the MASEI sub-scores (e.g., structural damage and activity scores) were calculated. The ASAS HI and the other SpA tools (e.g., Bath Ankylosing Spondylitis Disease Index, the Ankylosing Spondylitis Disease Activity Score) were used to evaluate patients' health and disease activity. Correlation and multivariate linear regression analyses were performed to assess the relationship between the MASEI and the ASAS HI. The mean score of the ASAS HI was 7.7 ± 4.6. The MASEI total score was calculated as 8.4 ± 6.8, while the mean MASEI-activity was 4.7 ± 3.6 and the mean MASEI-structural damage was 3.8 ± 4.5. There was no correlation between ASAS HI and MASEI total scores (r = 0.11, p = 0.34). However, the ASAS HI had a positive correlation with the MASEI-activity (r = 0.49, p < 0.001) and had a low negative correlation with the MASEI-structural damage (r = - 0.29, p < 0.05). In the linear regression model, the MASEI-activity and MASEI-structural damage were significantly related to the ASAS HI (β = 0.72 and - 0.58, respectively; R2 = 0.53 p < 0.001). This study reported that the ASAS HI score was more negatively affected by active entheseal lesions rather than structural lesions. We suggest adding the entheses evaluation with ultrasonography to other tools for monitoring the health status of patients with axSpA.
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Grobelski J, Recker F, Wilsmann-Theis D, Hartung W, Karakostas P, Brossart P, Schäfer VS. Etablierung und Validierung eines didaktischen muskuloskelettalen Ultraschallkurses für Dermatologen unter Verwendung eines innovativen Hand‐Ultraschallsystems – die MUDE‐Studie (Muskuloskelettaler Ultraschall für Dermatologen). J Dtsch Dermatol Ges 2021; 19:1753-1760. [PMID: 34894194 DOI: 10.1111/ddg.14614_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
HINTERGRUND Der muskuloskelettale Ultraschall (MSUS) schmerzhafter Gelenke spielt bei der Früherkennung der Arthritis, wie zum Beispiel der Psoriasisarthritis, eine wichtige Rolle. Pathologische Befunde können bei der klinischen Untersuchung übersehen werden, insbesondere wenn sie von Ärzten durchgeführt werden, die nicht in der Durchführung geschult sind. Das Ziel dieser Studie war die Untersuchung eines Pilot-MSUS-Kurses anhand des MUDE-Protokolls, welches speziell für Dermatologen entwickelt wurde. METHODIK Um den Grad der MSUS-Expertise der Teilnehmer zu ermitteln, wurde vor dem Kurs eine Umfrage mittels SurveyMonkey® durchgeführt. Das Kurskonzept umfasste nur die wichtigsten Ultraschallschnitte aller Gelenke und konzentrierte sich auf die Erkennung von Gelenkergüssen und Hyperperfusion der Synovia. Der Kurs bestand aus drei Modulen und wurde über sechs Monate durchgeführt. Das tragbare Butterfly IQ® System in Kombination mit einem Apple iPad wurde allen Teilnehmern zur Verfügung gestellt, um das Üben zwischen den Kursen zu ermöglichen. Die abschließende Lehrevaluation wurde als objective structured clinical examination (OSCE) durchgeführt. ERGEBNISSE Zwölf Dermatologen nahmen teil. Die Umfrage ergab keine Vorkenntnisse des MSUS. Die Gesamtpunktzahl aller Teilnehmer in der OSCE betrug 21,86 (87,44 %) von insgesamt 25 Punkten, was der Schulnote "gut" entsprach. SCHLUSSFOLGERUNG Das innovative Lehrkonzept MUDE eignet sich somit, unabhängig von Vorkenntnissen, in besonderer Weise für die Ausbildung von Dermatologen im MSUS.
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Affiliation(s)
- Jakub Grobelski
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn
| | - Florian Recker
- Klinik für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn
| | | | - Wolfgang Hartung
- Abteilung für Rheumatologie und Klinische Immunologie, Asklepios Klinik, Bad Abbach
| | - Pantelis Karakostas
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn
| | - Peter Brossart
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn
| | - Valentin Sebastian Schäfer
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn
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Grobelski J, Recker F, Wilsmann-Theis D, Hartung W, Karakostas P, Brossart P, Schäfer VS. Establishment and validation of a didactic musculoskeletal ultrasound course for dermatologists using an innovative handheld ultrasound system - the MUDE study (Musculoskeletal Ultrasound in Dermatology). J Dtsch Dermatol Ges 2021; 19:1753-1759. [PMID: 34821036 DOI: 10.1111/ddg.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the early detection of arthritis, such as psoriatic arthritis, musculoskeletal ultrasound (MSUS) of painful joints plays an important role in diagnosis. Pathological findings can be missed during clinical examination, especially if conducted by physicians who are not trained. The objective of this study was to examine a pilot MSUS course designed specifically for dermatologists, the MUDE protocol. METHODS To assess the degree of MSUS expertise of the participants, a questionnaire using SurveyMonkey® was completed before the course. The course concept covered only the most important ultrasound sections of all joints and focused on the detection of joint effusion and hyperperfusion. The course consisted of three modules and was carried out over six months. The portable Butterfly IQ® system in combination with an Apple iPad was provided to enable practice between the courses. The final teaching evaluation was carried out as an objective structured clinical examination (OSCE). RESULTS Twelve dermatologists participated. The survey revealed no prior knowledge of MSUS. The overall score of all participants in the OSCE was 21.86 (87.44 %) out of a total of 25 points, which corresponded to the school grade good. CONCLUSION The innovative MUDE protocol is thus particularly suitable for the training of dermatologists in MSUS, irrespective of prior knowledge.
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Affiliation(s)
- Jakub Grobelski
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany
| | - Dagmar Wilsmann-Theis
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Germany
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Pantelis Karakostas
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Germany
| | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Germany
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Mascarenhas S, Couette N. A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices. Diagnostics (Basel) 2021; 11:diagnostics11040669. [PMID: 33917826 PMCID: PMC8068272 DOI: 10.3390/diagnostics11040669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.
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Perez-Chada LM, Haberman RH, Chandran V, Rosen CF, Ritchlin C, Eder L, Mease P, Reddy S, Ogdie A, Merola JF, Scher JU. Consensus terminology for preclinical phases of psoriatic arthritis for use in research studies: results from a Delphi consensus study. Nat Rev Rheumatol 2021; 17:238-243. [PMID: 33589818 PMCID: PMC7997804 DOI: 10.1038/s41584-021-00578-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
The concept of psoriatic arthritis (PsA) prevention is gaining increased interest owing to the physical limitation, poor quality of life and low remission rates that are achieved with current therapies for PsA. The psoriasis-to-PsA transition offers a unique opportunity to identify individuals at increased risk of developing PsA and to implement preventive strategies. However, identifying individuals at increased risk of developing PsA is challenging as there is no consensus on how this population should be defined. This Consensus Statement puts forward recommended terminology from the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) for defining specific subgroups of individuals during the preclinical and early clinical phases of PsA to be used in research studies. Following a three-round Delphi process, consensus was reached for three terms and definitions: 'increased risk for PsA', 'psoriasis with asymptomatic synovio-entheseal imaging abnormalities' and 'psoriasis with musculoskeletal symptoms not explained by other diagnosis'. These terms and their definitions will enable improved identification and standardization of study populations in clinical research. In the future, as increasing evidence emerges regarding the molecular and clinical features of the psoriasis-to-PsA continuum, these terms and definitions will be further refined and updated.
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Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca H Haberman
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.,Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Cheryl F Rosen
- Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Christopher Ritchlin
- Allergy, Immunology, and Rheumatology Division, University of Rochester Medical School, Rochester, NY, USA
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Philip Mease
- Seattle Rheumatology Associates, Swedish Medical Center and Providence St, Joseph Health, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Soumya Reddy
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Alexis Ogdie
- Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph F Merola
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA.
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Mascarenhas S. A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon. Diagnostics (Basel) 2020; 10:E944. [PMID: 33202763 PMCID: PMC7696236 DOI: 10.3390/diagnostics10110944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022] Open
Abstract
Enthesitis is a cardinal feature of spondyloarthropathies. The Achilles insertion on the calcaneus is a commonly evaluated enthesis located at the hindfoot, generally resulting in hindfoot pain and possible tendon enlargement. For decades, diagnosis of enthesitis was based upon patient history of hindfoot or posterior ankle pain and clinical examination revealing tenderness and/or enlargement at the site of the tendon insertion. However, not all hindfoot or posterior ankle symptoms are related to enthesitis. Advanced imaging, including magnetic resonance imaging (MRI) and ultrasound (US), has allowed for more precise evaluation of hindfoot and posterior ankle conditions. Use of US in diagnosis has helped confirm some of these cases but also identified other conditions that may have otherwise been misclassified without use of advanced imaging diagnostics. Conditions that may result in hindfoot and posterior ankle symptoms related to the Achilles tendon include enthesitis (which can include retrocalcaneal bursitis and insertional tendonopathy), midportion tendonopathy, paratenonopathy, superficial calcaneal bursitis, calcaneal ossification (Haglund deformity), and calcific tendonopathy. With regard to classification of these conditions, much of the existing literature uses confusing nomenclature to describe conditions in this region of the body. Some terminology may imply inflammation when in fact there may be none. A more uniform approach to classifying these conditions based off anatomic location, symptoms, clinical findings, and histopathology is needed. There has been much debate regarding appropriate use of tendonitis when there is no true inflammation, calling instead for use of the terms tendinosis or tendonopathy. To date, there has not been clear examination of a similar overuse of the term enthesitis in conditions where there is no underlying inflammation, thus raising the need for more comprehensive taxonomy.
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Affiliation(s)
- Sheryl Mascarenhas
- Department of Internal Medicine, Division of Rheumatology, The Ohio State University Wexner Medical Center, 543 Taylor Ave, Columbus, OH 43203, USA
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Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int 2020; 40:837-848. [PMID: 32211929 DOI: 10.1007/s00296-020-04559-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/14/2020] [Indexed: 01/08/2023]
Abstract
Many rheumatic diseases may present with an inflammatory joint syndrome, affecting the small joints of the hands, of which rheumatoid (RA) and psoriatic arthritis (PsA) being one of the most common. The aim of this systematic review was to focus on the literature evidence regarding the added value of ultrasound (US) of the hand in the differential diagnosis between RA and PsA. Pubmed and Scopus were searched to identify original manuscripts, published in the last 20 years utilising ultrasonography to reveal specific hand US patterns. Studies were eligible if they: (1) included adults (over 18 years) with a diagnosis of RA/PsA; (2) were published in the English language; (3) were published in peer-reviewed journals; (4) included description of the US machine; (5) used US for assessment of hand joints, periarticular tissues and nails. The search yielded 322 published studies, of which 16 were deemed relevant and were included in the present study. Overall, there was heterogeneity with regard to the pathology examined. Based on the included studies analysis, hand US patterns have several basic features to be considered-location of gray scale (GS) inflammatory findings, involvement of periarticular soft tissue, distribution and extent of Doppler signal (intra- and peri-articular), bone reaction, shape and location of erosions, involvement of tendons without synovial sheath, involvement of enthesis and nail abnormalities. Future research could focus on determining the sensitivity and specificity of the different US detected hand patterns in patients with early arthritis.
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Affiliation(s)
- Tanya Sapundzhieva
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria. .,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria.
| | - Rositsa Karalilova
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria.,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria.,Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia Str, Block 2, Eight Floor, 4002, Plovdiv, Bulgaria
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Zardi EM, Pipita ME, Giorgi C, Afeltra A, Maffulli N, Franceschi F. Strain Ultrasound Elastography in the Achilles Tendon of Ankylosing Spondylitis Patients Treated With Anti-TNF-α: A Preliminary Study. In Vivo 2020; 33:1635-1640. [PMID: 31471416 DOI: 10.21873/invivo.11648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM To compare patients affected by ankylosing spondylitis (AS) treated with anti-TNF-α for two years with controls in terms of Achilles tendon stiffness, ultrasound structure and thickness. PATIENTS AND METHODS B-mode ultrasound evaluation and strain ultrasound elastography were performed in longitudinal and transverse planes on 22 Achilles tendons of 11 AS patients and 26 of 13 controls. RESULTS There were no significant differences in thickness and stiffness of the Achilles tendon between AS patients and controls, except for an increased thickness in the middle third of the tendon in the AS patients (p=0.04). The Achilles tendon stiffness ratio of AS patients was 1.02±0.36 vs. 1.14±0.38 in the controls (p=0.2). CONCLUSION AS patients had an Achilles tendon thickness greater than controls at the middle third, but no difference in the stiffness was found among them. Strain ultrasound elastography may be useful to exclude early changes in mechanical properties of tendons.
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Affiliation(s)
- Enrico M Zardi
- Internistic Ultrasound Service "Campus Bio-Medico" University, Rome, Italy
| | - Maria Elena Pipita
- Internistic Ultrasound Service "Campus Bio-Medico" University, Rome, Italy
| | - Chiara Giorgi
- Radiology Department, S. Maria della Misericordia Hospital, Urbino, Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, U.K.,School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton, Keele University, Newcastle, U.K
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
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Brunner E, Ting T, Vega-Fernandez P. Musculoskeletal ultrasound in children: Current state and future directions. Eur J Rheumatol 2020; 7:S28-S37. [PMID: 35929859 PMCID: PMC7004269 DOI: 10.5152/eurjrheum.2019.19170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 10/20/2019] [Indexed: 08/07/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory arthritides that if inadequately treated, may be associated with chronic disability and deformity. Early diagnosis and treatment initiation is essential in the management of patients with JIA. Conventional means of evaluation of disease presence, disease activity and response to therapy including physical exam, labs and x-rays are at times limited and may be insufficient in making an accurate assessment. Musculoskeletal ultrasound (MSUS) is a well-established modality that is patient and family-friendly, non-invasive, does not require sedation and can be performed at the bedside in real-time. MSUS offers information that cannot be attained by standard outcome measures, and may help to advance both diagnosis and treatment of patients with JIA ultimately improving patient outcomes. This review explores the background of MSUS and the current evidence to support its potential role as a diagnostic, disease activity monitoring and interventional tool.
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Affiliation(s)
| | - Tracy Ting
- Department of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patricia Vega-Fernandez
- Department of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Eder L, Aydin SZ. Imaging in Psoriatic Arthritis-Insights About Pathogenesis of the Disease. Curr Rheumatol Rep 2018; 20:77. [PMID: 30370449 DOI: 10.1007/s11926-018-0793-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Heterogeneity is a hallmark of PsA as musculoskeletal inflammation can affect different tissues including the synovial joint, tendons, entheses, bursa, and bone. RECENT FINDINGS Relying on clinical examination for investigating underlying mechanisms in PsA is limited by the inherent inaccuracies of examination of the joints, enthesis, and spine. In addition, unlike synovial-centered diseases, histology is hard to obtain for the entheses and spine, limiting the knowledge for different manifestations of PsA. These limitations prompted the use of imaging modalities to improve our understanding of the underlying mechanisms in PsA. Imaging modalities can identify and quantify the extent of inflammation and damage in the synovial joints, entheses, and tendons which all contribute to the heterogeneity of PsA. This review summarizes the contribution of imaging to the understanding of the underlying mechanisms of different clinical manifestations of PsA.
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Affiliation(s)
- Lihi Eder
- Women's College Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Sibel Zehra Aydin
- Division of Rheumatology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Baccouche K, Mani L, Elamri N, Fathallah N, Zaghouani H, Belghali S, Zeglaoui H, Bouajina E. Musculoskeletal ultrasonography of the Achilles tendon and plantar fascia in spondyloarthritis patients. THE EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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15
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Elalouf O, Bakirci Ureyen S, Touma Z, Anderson M, Kaeley GS, Aydin SZ, Eder L. Psoriatic Arthritis Sonographic Enthesitis Instruments: A Systematic Review of the Literature. J Rheumatol 2018; 46:43-56. [DOI: 10.3899/jrheum.171466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
Abstract
Objective.As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) ultrasound working group, we performed a systematic review of the literature to assess the evidence and knowledge gaps in scoring instruments of enthesitis in psoriatic arthritis (PsA).Methods.A systematic search of PubMed, EMBase, and Cochrane databases was performed. The search strategy was constructed to find original publications containing terms related to ultrasound, enthesitis, spondyloarthritis (SpA) or PsA. Data extraction focused on the properties of the sonographic enthesitis instruments used in each study following components of the Outcome Measures in Rheumatology (OMERACT) filter: feasibility, test-retest reliability, construct validity as related to clinical assessment of enthesitis, biomarkers of inflammation and imaging of enthesitis by other modalities, discriminative validity, and responsiveness to treatment.Results.Fifty-one of 310 identified manuscripts were included. Only 1 scoring instrument of enthesitis was specifically developed and validated in patients with PsA. Only 18 (35%) of the studies involved patients with PsA, while the remaining studies focused on SpA. In PsA, construct validity was assessed using biomarkers and clinical examination in 1 (2%) and 11 (21.5%) of the studies, respectively, whereas no studies used imaging for the same purpose. Only 2 (4%) of the studies assessed discriminative validity in PsA. Responsiveness to treatment was assessed in 7 studies, none of which included patients with PsA.Conclusion.Although sonographic enthesitis scoring instruments have been developed for SpA, only a few have been validated in PsA. None of them passed the OMERACT filter in patients with PsA. Additional research is required before endorsing a specific instrument for the assessment of enthesitis in patients with PsA.
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Acquitter M, Misery L, Saraux A, Bressollette L, Jousse-Joulin S. Detection of subclinical ultrasound enthesopathy and nail disease in patients at risk of psoriatic arthritis. Joint Bone Spine 2017; 84:703-707. [DOI: 10.1016/j.jbspin.2016.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/21/2016] [Indexed: 01/15/2023]
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Ruyssen-Witrand A, Jamard B, Cantagrel A, Nigon D, Loeuille D, Degboe Y, Constantin A. Relationships between ultrasound enthesitis, disease activity and axial radiographic structural changes in patients with early spondyloarthritis: data from DESIR cohort. RMD Open 2017; 3:e000482. [PMID: 28955496 PMCID: PMC5604709 DOI: 10.1136/rmdopen-2017-000482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/13/2017] [Accepted: 08/14/2017] [Indexed: 11/06/2022] Open
Abstract
Background To search for association between ultrasound (US) enthesis abnormalities and disease activity, spine and sacro-iliac joints (SIJ) MRI inflammatory lesions and spine structural changes in a cohort of patients suspected for axial spondyloarthritis (SpA). Methods Patients: Of 708 patients included in the DESIR(Devenir des Spondyloarthrites Indifférenciées Récentes) cohort, 402 had an US enthesis assessment and were selected for this study. Imaging: Achilles, lateral epicondyles, superior patellar ligament, inferior patellar ligament entheses were systematically US scanned and abnormalities were summed in US structural and power Doppler (PDUS) scores. Spine radiographs, SIJ and spine MRI scans were centrally scored modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), presence of MRI sacro-iliitis, Spondyloarthritis Research Consortium of Canada and Berlin scores. Analysis: The associations between the US structural/PDUS scores and disease activity, C reactive protein (CRP), MRI SIJ and spine inflammatory lesions and mSASSS were tested by Spearman's correlation tests. Results Among the 402 patients included (median age: 33.5 years, males: 48.5%), 55% had US enthesis structural abnormalities while 14% had PDUS abnormalities. There was no association between US scores and Bath Ankylosing Spondylitis Disease Activity Index, CRP or inflammatory lesions on SIJ and spine MRI. There was a correlation between US structural and PDUS scores and the mSASSS (respectively, r=0.151, p=0.005; r=0.143, p=0.007). The proportion of patients with syndesmophytes was higher in the case of US enthesophytes (26% of syndesmophytes vs 6% in the absence of US enthesophytes, p<0.0001). Conclusion While the US abnormalities do not seem to be a helpful tool for monitoring disease activity in axial SpA, US enthesophytes, strongly associated with axial syndesmophytes, might be a marker of interest for disease severity. Trial registration number NCT01648907, date of registration : 20 July 2012.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Inserm UMR1027, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Bénédicte Jamard
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France
| | - Alain Cantagrel
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France.,Inserm UMR 1043, Toulouse, France
| | - Delphine Nigon
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France
| | | | | | - Arnaud Constantin
- Department of Rheumatology, Purpan Teaching Hospital, Toulouse, France.,Department of Rheumatology, Université Paul Sabatier Toulouse III, Toulouse, France.,Inserm UMR 1043, Toulouse, France
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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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Ultrasound Imaging for Prompt Monitorization of the Treatment Response in Patients with Multi-joint Involvement. W INDIAN MED J 2015; 64:459. [PMID: 26624610 DOI: 10.7727/wimj.2014.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022]
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Carroll M, Dalbeth N, Boocock M, Rome K. The assessment of lesions of the Achilles tendon by ultrasound imaging in inflammatory arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2015; 45:103-14. [PMID: 25910404 DOI: 10.1016/j.semarthrit.2015.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/24/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Ultrasound (US) is a highly sensitive, reliable and non-invasive tool, which allows for the assessment of lesions of tendons and entheseal sites. The aim of this systematic review and meta-analysis is to identify differences in US lesions of the Achilles tendon (AT) between people with inflammatory arthritis (IA) and healthy controls. METHODS An electronic literature search was performed on Medline, CINAHL, SportDiscus and The Cochrane Library. Methodological quality was assessed using a modified Quality Index. Odds ratios with 95% confidence intervals (CI) were determined. Meta-analysis was conducted on those studies that were considered to be homogenous. RESULTS A total of 13 high-to-medium quality studies met the inclusion criteria. The majority of studies reported US lesions in spondyloarthropathy (SpA), with limited evidence for other forms of IA. US lesions were not consistently defined with regard to Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions, and numerous scoring systems were used across the majority of studies. The mean AT thickness at the enthesis in people with SpA was 0.54mm thicker (95% CI: 0.10-0.97mm) with more frequent erosions in people with SpA (odds ratio = 7.43, 95% CI: 1.99-27.77, P = 0.003) and rheumatoid arthritis (RA) (odds ratio = 9.60, 95% CI: 1.23-74.94, P = 0.03), compared to controls. There was no significant difference in the frequency of enthesophyte formation in people with SpA compared to the controls (odds ratio = 2.48, 95% CI: 0.64-9.70, P = 0.19). CONCLUSIONS The systematic review identified that a majority of studies reporting US lesions were in SpA, but limited evidence relating to other forms of IA. Consistent application of the OMERACT US definitions and scoring of US lesions is required in future studies of AT disease in IA. Further work is also required to distinguish between US lesions reflective of inflammation and structural damage.
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Affiliation(s)
- Matthew Carroll
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Mark Boocock
- Department of Physiotherapy, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Keith Rome
- Department of Podiatry, Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Epis O, Paoletti F, d'Errico T, Favalli E, Garau P, Mancarella L, Pomponio G, Sandri G, Scioscia C, Selvi E, Tirri E. Ultrasonography in the diagnosis and management of patients with inflammatory arthritides. Eur J Intern Med 2014; 25:103-11. [PMID: 24041708 DOI: 10.1016/j.ejim.2013.08.700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/04/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings.
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Affiliation(s)
- Oscar Epis
- S.C. Reumatologia, A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
| | - Franco Paoletti
- U.O. Reumatologia, Ospedale 'S. Francesco Caracciolo', Agnone, Italy
| | - Tito d'Errico
- Ambulatiorio di Reumatologia, P.O. 'S.M.d.P degli Incurabili', Napoli, Italy
| | - Ennio Favalli
- Divisione di Reumatologia, Istituto Ortopedico G. Pini, Milano, Italy
| | - Pietro Garau
- Struttura Complessa di Reumatologia, A.O.U. Cagliari, Italy
| | | | | | - Gilda Sandri
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Italy
| | | | - Enrico Selvi
- Sezione di Reumatologia, A.O.U. Senese, Siena, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale 'S. Giovanni Bosco', Napoli, Italy
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Eder L, Jayakar J, Thavaneswaran A, Haddad A, Chandran V, Salonen D, Rosen CF, Gladman DD. Is the Madrid Sonographic Enthesitis Index Useful for Differentiating Psoriatic Arthritis from Psoriasis Alone and Healthy Controls? J Rheumatol 2014; 41:466-72. [DOI: 10.3899/jrheum.130949] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To assess the usefulness of the MAdrid Sonographic Enthesitis Index (MASEI) in classifying patients as having psoriatic arthritis (PsA) and comparing entheseal abnormalities between patients with PsA, psoriasis alone (PsC), and healthy controls (HC).Methods.Patients with PsC were assessed to exclude inflammatory arthritis. The MASEI scoring system was used to quantify the extent of ultrasonographic (US) entheseal abnormalities. The total MASEI score was categorized into items that reflected inflammatory abnormalities (MASEI-inflammatory) and chronic damage (MASEI-damage). Nonparametric tests were used to compare MASEI scores across the groups. A cutoff point of MASEI ≥ 20 was used to calculate the sensitivity and specificity of the MASEI to classify patients as having PsA.Results.Patients with PsA (n = 50), PsC (n = 66), and HC (n = 60) were assessed. Total MASEI scores were higher in patients with PsA than in those with PsC, and both those groups were higher than HC (p < 0.0001). MASEI-inflammatory showed a similar trend (p < 0.0001). MASEI-damage was higher in patients with PsA compared to both patients with PsC and HC (p < 0.0001); however, no difference was observed between patients with PsC and HC. No significant difference in MASEI scores was found across the 3 groups in patients with a body mass index > 30. The sensitivity of the MASEI score to correctly classify patients as having PsA was 30% and the specificity was 95% when compared to HC and 89% when compared to PsC.Conclusion.The severity of US entheseal abnormalities is highest in patients with PsA followed by PsC and is lowest in healthy controls. MASEI can specifically classify patients as having PsA.
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Ali Ou Alla S, Bahiri R, Amine H, El Alaoui H, Rkain H, Aktaou S, Abouqal R, Hajjaj-Hassouni N. Ultrasound features of shoulder involvement in patients with ankylosing spondylitis: a case-control study. BMC Musculoskelet Disord 2013; 14:272. [PMID: 24053556 PMCID: PMC3849072 DOI: 10.1186/1471-2474-14-272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background During Ankylosing spondylitis (AS) courses, shoulder involvement is common. However, etiologies of shoulder pain in patients with AS remain to be defined. The aim of this study was to investigate the prevalence of ultrasound (US) abnormalities in shoulders of patients with ankylosing spondylitis (AS), and to determine predictive factors of ultrasound shoulder enthesitis. Methods 38 patients with AS were included with 38 age and sex-matched healthy controls. All patients fulfilled the modified New York criteria for ankylosing spondylitis. Clinical and demographical data were recorded. US examination of bilateral shoulders was performed by a musculoskeletal sonographer according to a defined protocol that included imaging of the insertions of supraspinatus, subscapularis and infraspinatus tendons, rotator cuff tendons, subacromial-subdeltoid bursa, acromioclavicular joint, and glenohumeral joint. Results The mean age of patients and controls was 36 years, each group of patients and controls comprised 22 men (57.9%) and 16 women (42.1%). Disease duration was 9.6 ± 7.2 years. Among 38 patients with AS, 21 had coxitis (55%) and 19 had previous or current shoulder pain (50%). AS shoulders presented significantly more ultrasound enthesitis than controls shoulders (43 shoulders (56.6%) versus 8 shoulders (10.5%) respectively). Involvement of rotator cuff tendons was significantly higher in patients with AS compared with control subjects (16/38 (42.1%) versus 6 (15.2%) respectively). However, involvement of gleno-humeral and acromio-clavicular joints was infrequent in both groups. In patients with AS, we found that the presence of coxitis was the only significant predictive factors of shoulder enthesitis (Odds Ratio (OR) = 9.4; Confidence interval (CI) 95% (1.10; 81.9), p = 0.04). Conclusions Ultrasound abnormalities of shoulders are common in patients with AS, and the most frequent abnormalitie was enthesitis, which was associated with the presence of coxitis.
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Affiliation(s)
- Sanae Ali Ou Alla
- Department of Rheumatology, El Ayachi Hospital, University Hospital of Rabat-Sale, Rabat-Sale, Morocco.
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D’Agostino MA, Saraux A, Chary-Valckenaere I, Marcelli C, Guis S, Gaudin P, Aegerter P, Jousse-Joulin S, Loeuille D, Judet O, Lecoq B, Hacquard-Bouder C, Grange L, Guzian MC, Blum A, Chagnaud C, Leboime A, Monnet D, Rat AC, Timsit MA, Said-Nahal R, Breban M. Can we improve the diagnosis of spondyloarthritis in patients with uncertain diagnosis? The EchoSpA prospective multicenter French cohort. Joint Bone Spine 2012; 79:586-90. [DOI: 10.1016/j.jbspin.2012.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 02/06/2012] [Indexed: 11/25/2022]
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KAELEY GURJITS, D’AGOSTINO MARIAANTONIETTA, GRASSI WALTER, ØSTERGAARD MIKKEL, OLIVIERI IGNAZIO. GRAPPA 2011: Proceedings from the Ultrasound Imaging Module. J Rheumatol 2012; 39:2211-3. [DOI: 10.3899/jrheum.120826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In a plenary session at the 2011 meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) the use of sonography for evaluating enthesitis and dactylitis in psoriasis and psoriatic arthritis (PsA) was reviewed, and initial proposals were presented to develop ultrasound joint indices to assess enthesitis and dactylitis in PsA. Sonography can depict ultrastructural morphopathological features of an enthesis and its adjoining tissue structures, as well as increased vascularity; candidate entheses were proposed for an initial sonographic PsA enthesitis index. Ultrasound also can readily demonstrate soft tissue changes, synovitis, erosions, and osteoproliferation in dactylitis, and these features were proposed for an initial sonographic dactylitis index. A perspective was also presented on a wider proposed index including the skin, nail, joint, and enthesis.
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