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Er G, Palamar D, Akgün K, Asoğlu İ, Sarı H. The relationship between clinical parameters and ultrasonographic enthesitis assessment in patients with spondyloarthritis. Arch Rheumatol 2024; 39:242-254. [PMID: 38933722 PMCID: PMC11196222 DOI: 10.46497/archrheumatol.2024.10224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/10/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives The study aimed to evaluate the role of ultrasonographic assessment of enthesitis in patients with spondyloarthritis (SpA) in terms of disease activity, functionality, and quality of life. Patients and methods Ninety SpA patients (57 males, 33 females; mean age: 37.5±9.7 years; range, 18 to 60 years) were included in cross-sectional study between November 2016 and January 2017. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Short Form-12 (SF-12), and Ankylosing Spondylitis Quality of Life (ASQoL) were utilized for clinical evaluation. The clinical evaluation of enthesitis was performed with the Spondyloarthritis Research Consortium of Canada (SPARCC) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) via an algometer calibrated to 4 kg/cm2 of pressure. Ultrasound evaluation was performed according to Madrid Sonographic Enthesitis Index (MASEI). A total of 2,610 entheseal sites were examined clinically, and 1,080 were assessed ultrasonographically. Results A significant proportion of enthesitis (463/1,080) was detected on ultrasonographic evaluation but not with clinical enthesitis score (MASES and SPARCC). Although ultrasonographic entheseal evaluation detected enthesitis in at least one enthesis of all patients, 35 of the patients had no enthesitis with clinical examination. The sites most frequently involved in the entheses were the proximal patellar tendon and Achilles tendon. The MASEI score did not correlate with the MASES, SPARCC, BASDAI, SF-12, and ASQoL but moderately correlated with the C-reactive protein (CRP) level (r=0.348), ASDAS-CRP (r=0.294), and BASFI score (r=0.244). Conclusion The association of ultrasonography scores with CRP levels and ASDAS-CRP indicates that ultrasonography is effective in detecting inflammation. The MASEI score weakly correlates with functionality but not with quality of life. Ultrasonographic evaluation is invaluable and merits to be incorporated into SpA disease scoring system.
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Affiliation(s)
- Gunay Er
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Istanbul, Türkiye
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Kenan Akgün
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - İbrahim Asoğlu
- Department of Physical Medicine and Rehabilitation, Malatya Training and Research Hospital, Malatya, Türkiye
| | - Hidayet Sarı
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, Istanbul, Türkiye
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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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3
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Frede N, Hiestand S, Endres D, van Elst LT, Finzel S, Chevalier N, Schramm MA, Rump IC, Thiel J, Voll R, Herget G, Venhoff N. Burden of disease and impact on quality of life in chronic back pain - a comparative cross-sectional study of 150 axial spondyloarthritis and 150 orthopedic back pain patients. Front Med (Lausanne) 2023; 10:1221087. [PMID: 37663655 PMCID: PMC10469952 DOI: 10.3389/fmed.2023.1221087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Objective Chronic back pain (CBP) constitutes one of the most common complaints in primary care and a leading cause of disability worldwide. CBP may be of mechanical or inflammatory character and may lead to functional impairment and reduced quality of life. In this study, we aimed to assess and compare burden of disease, functional capacity, quality of life and depressive symptoms in axial spondyloarthritis (axSpA) patients with orthopedic chronic back pain patients (OBP). We further aimed to identify factors associated with quality of life. Methods Cross-sectional survey of a cohort of 300 CBP patients including 150 patients from a University Hospital Orthopedic Back Pain Outpatient Clinic with OBP and 150 patients with confirmed axSpA from a University Hospital Rheumatology Outpatient Clinic. Questionnaire-based assessment of pain character (Inflammatory Back Pain, MAIL-Scale), functional status (FFbH, BASFI), quality of life (WHOQOL-Bref) and depressive symptoms (Phq9) and retrospective medical chart analysis. Results Both, OBP and axSpA patients reported on average intermediate pain levels of mostly mixed pain character. Both groups demonstrated a reduced health-related quality of life and the presence of depressive symptoms. However, axSpA patients reported a significantly better subjective quality of life, more satisfaction with their health status and better functional capacity compared to OBP patients (all p < 0.001). In a multivariate regression model, depressive symptoms, mechanical back pain, pain level and age were negative predictors of subjective quality of life, whereas functional capacity was a positive predictor. Conclusion Chronic back pain was associated with a high morbidity and reduced quality of life regardless of pain character. We identified multiple factors associated with reduced quality of life. Awareness and addressing of these factors may help to overcome unmet needs and improve quality of life for these patients.
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Affiliation(s)
- Natalie Frede
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sonja Hiestand
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nina Chevalier
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus A. Schramm
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ina C. Rump
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Division of Rheumatology and Clinical Immunology, Medical University Graz, Graz, Austria
| | - Reinhard Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Herget
- Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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4
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Fırat SN, Kuşkonmaz ŞM, Önder ÇE, Omma T, Genç H, Çulha C. Sonographic evaluation of subclinical entheseal involvement in patients with hypoparathyroidism: a case control study. J Endocrinol Invest 2023; 46:133-139. [PMID: 35982371 DOI: 10.1007/s40618-022-01891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/29/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Hypoparathyroidism is a disease characterized by low serum calcium, increased serum phosphorus and low PTH levels. Although patients are treated with active vitamin D and calcium, a proper serum calcium phosphorus balance cannot always be achieved. Ectopic calcifications that develop in organs during treatment are the most common complications. To date, there is not any published study on enthesopathy in patients with hypoparathyroidism. The aim of this study was to evaluate subclinical enthesopathy in patients with hypoparathyroidism with ultrasound and to compare the results with those of the control group. METHODS The study included patients aged 18-65 years with postoperative hypoparathyroidism and hypothyroidism (group hypoP + hypoT), patients with postoperative hypothyroidism (group hypoT), and healthy age and sex-matched volunteers (group C). Ultrasonographic findings of enthesopathy in both extremities were documented according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS GUESS scores in group hypoP + hypoT, were significantly higher when compared to the other groups. There was a statistically significant correlation between the total GUESS scores and total enthesophyte scores and the duration of hypoparathyroidism (p < 0.05, r = 0.43) (p < 0.05, r = 0.39) respectively. In the correlation analysis of all groups, a significant negative correlation was found between serum Ca and PTH levels and the total GUESS scores (p < 0.01, r = - 0.37; p < 0.01, r = - 0.54, respectively). CONCLUSION This study showed that GUESS scores were significantly higher in patients with hypoparathyroidism compared to those with hypothyroidism and control subjects. GUESS scores were positively correlated with disease duration. Patients with hypoparathyroidism need to be evaluated for subclinical enthesopathy during follow-up.
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Affiliation(s)
- S N Fırat
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey.
| | - Ş M Kuşkonmaz
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
| | - Ç E Önder
- Department of Endocrinology and Metabolism, Niğde Ömer Halisdemir University Training and Research Hospital, Niğde, Turkey
| | - T Omma
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
| | - H Genç
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - C Çulha
- Department of Endocrinology and Metabolism, University of Health Sciences Ankara Training and Research Hospital, HacettepeMah., Ulucanlar Cad., Altindag, 06230, Ankara, Turkey
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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García Salinas R, Ruta S, Chichande JT, Prado ES, Ruta A, Salvatori F, Aguerre D, Magri S. "Reuma-Check": Performance of a Comprehensive Fast-Track Program for the Diagnosis of Axial Spondyloarthritis in South America. J Clin Rheumatol 2021; 27:175-181. [PMID: 33783180 DOI: 10.1097/rhu.0000000000001654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the performance of a comprehensive diagnosis program called "Reuma-check" for the diagnosis of axial spondyloarthritis (SpA) in patients with low back pain (LBP). METHODS This is a cross-sectional study. Patients with LBP aged 18 years or older were preselected, and those with at least 1 SpA feature completed the circuit. They were referred after 2 strategies: education for orthopedists and a campaign on social networks. All patients underwent a clinical evaluation, laboratory testing, and imaging (including human leukocyte antigen B27 evaluation and magnetic resonance imaging). The diagnosis of axial SpA was established by an expert rheumatologist opinion. Time from onset of symptoms to "Reuma-check," time from patient referral to admission of the checkup, and time from "Reuma-check" to diagnosis were evaluated. RESULTS A total of 175 of 246 patients were included, most of them came from the social media campaign (55%). Seventy-five (43%) of 175 patients were diagnosed as axial SpA. The median time from referral (or self-referral) to access to the program was 1.3 months. The median time from symptoms onset to access to the program was 31.7 months, and the median time from the performance of "Reuma-check" to final diagnosis was 2 weeks. Features associated with a diagnosis of axial SpA were as follows: inflammatory LBP (odds ratio [OR], 6.64; 95% confidence interval [CI], 1.6-28), clinical enthesopathy (OR, 4.56; 95% CI, 1.1-18.4), positive human leukocyte antigen B27 (OR, 23.02; 95% CI, 3.5-58), and positive magnetic resonance imaging (OR, 14.34; 95% CI, 3.5-58). CONCLUSIONS "Reuma-check" allowed a high frequency of axial SpA diagnosis and improved access to rapid diagnosis, shortening the time from referral to diagnosis with a shorter acquisition time for the ancillary studies. Patients with a final diagnosis of axial SpA presented distinctive features.
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Affiliation(s)
| | | | | | | | | | | | - Dario Aguerre
- Radiology Department, Hospital Italiano de La Plata, La Plata, Argentina
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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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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Lewinson RT, Vallerand IA, Parsons LM, LaMothe JM, Frolkis AD, Lowerison MW, Kaplan GG, Patten SB, Barnabe C. Psoriasis and the risk of foot and ankle tendinopathy or enthesopathy in the absence of psoriatic arthritis: a population-based study. RMD Open 2018; 4:e000668. [PMID: 29862046 PMCID: PMC5976107 DOI: 10.1136/rmdopen-2018-000668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/02/2018] [Accepted: 05/01/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives Imaging studies in patients with cutaneous psoriasis have demonstrated asymptomatic bone and tendon changes, commonly of the foot and ankle. We sought to determine if patients with cutaneous psoriasis have an increased risk of clinically significant foot and ankle tendinopathy or enthesopathy compared with the general population. Methods Patients with cutaneous psoriasis and a general population cohort were identified in The Health Improvement Network, a general practice medical records database from the UK. All patients with psoriatic arthritis were excluded. Cox proportional-hazards models (α=0.05) estimated the HR for development of foot and ankle tendinopathy or enthesopathy among patients with psoriasis, with adjustment for numerous covariates. Results In total, 78 630 patients with cutaneous psoriasis and 5 983 338 persons from the general population were identified. In an unadjusted model, patients with cutaneous psoriasis had a 25% increased risk of developing foot and ankle tendinopathy or enthesopathy compared with the general population (HR 1.25, 95% CI 1.20 to 1.30, p<0.0001). The HR remained unchanged and statistically significant after adjusting for covariates, and in sensitivity analyses. Conclusions These data suggest that patients with psoriasis can have foot and ankle tendinopathy or enthesopathy without having psoriatic arthritis, presenting a diagnostic challenge to physicians. Further research is needed to elucidate mechanisms contributing to this increased risk.
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Affiliation(s)
- Ryan T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Biomedical Engineering Program, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle A Vallerand
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurie M Parsons
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeremy M LaMothe
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra D Frolkis
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark W Lowerison
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Acosta-Felquer ML, Ruta S, Rosa J, Marin J, Ferreyra-Garrot L, Galimberti ML, Galimberti R, Garcia-Monaco R, Soriano ER. Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory. Semin Arthritis Rheum 2017. [DOI: 10.1016/j.semarthrit.2017.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schett G, Lories RJ, D'Agostino MA, Elewaut D, Kirkham B, Soriano ER, McGonagle D. Enthesitis: from pathophysiology to treatment. Nat Rev Rheumatol 2017; 13:731-741. [DOI: 10.1038/nrrheum.2017.188] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ruta S, Marin J, Acosta Felquer ML, Ferreyra-Garrot L, Rosa J, García-Monaco R, Soriano ER. Utility of Power Doppler Ultrasound–detected Synovitis for the Prediction of Short-term Flare in Psoriatic Patients with Arthritis in Clinical Remission. J Rheumatol 2017; 44:1018-1023. [DOI: 10.3899/jrheum.161347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 11/22/2022]
Abstract
Objective.Power Doppler ultrasound (PDUS) has been shown to detect subclinical synovitis in psoriatic arthritis (PsA), but its value is not yet fully understood. The aim of this study was to evaluate PDUS features at joint level in patients with PsA in clinical remission and to investigate its value for predicting short-term flares.Methods.Consecutive patients with PsA in clinical remission according to the attending rheumatologist and who fulfill minimal disease activity criteria and/or 28-joint Disease Activity Score in remission criteria underwent PDUS examination of 18 joints. All patients were followed up for 6 months. Disease flare was defined as any increase of disease activity generating the need of any of the following changes in therapy with disease-modifying antirheumatic drugs (DMARD) by the attending rheumatologist: dose increase, switch or addition of a different DMARD, and/or switch or addition of biological therapies.Results.Among 54 patients with PsA in clinical remission, 15 (27.8%) experienced a flare within the next 6 months. Twenty patients had at least 1 joint with PDUS synovitis at baseline, and 13 (65%) of these had a disease flare during the followup period compared with only 2 of the 34 patients (5.9%) without baseline PDUS synovitis (relative risk = 11, 95% CI 2.8–44, p < 0.001). On logistic regression analysis, the only variables associated with short-term flares were baseline PDUS synovitis and the use of nonbiologic DMARD.Conclusion.Among patients with PsA in clinical remission, PDUS-detected synovitis was a strong predictor of short-term flare of the disease.
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Uson J, Loza E, Möller I, Acebes C, Andreu JL, Batlle E, Bueno Á, Collado P, Fernández-Gallardo JM, González C, Jiménez Palop M, Lisbona MP, Macarrón P, Maymó J, Narváez JA, Navarro-Compán V, Sanz J, Rosario MP, Vicente E, Naredo E. Recommendations for the Use of Ultrasound and Magnetic Resonance in Patients With Spondyloarthritis, Including Psoriatic Arthritis, and Patients With Juvenile Idiopathic Arthritis. ACTA ACUST UNITED AC 2017; 14:27-35. [PMID: 28277255 DOI: 10.1016/j.reuma.2016.08.008] [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] [Received: 03/16/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. METHODS Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.
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Affiliation(s)
- Jacqueline Uson
- Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | | | - Ingrid Möller
- Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España
| | - Carlos Acebes
- Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España
| | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Enrique Batlle
- Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España
| | - Ángel Bueno
- Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Paz Collado
- Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | - Carlos González
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Mercedes Jiménez Palop
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Pilar Macarrón
- Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Joan Maymó
- Servicio de Reumatología, Hospital del Mar, Barcelona, España
| | - Jose Antonio Narváez
- Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Esther Vicente
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España
| | - Esperanza Naredo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Lanfranchi MA, Leluc O, Tavano A, Wormser C, Morange S, Chagnaud C, Pradel V, Lafforgue P, Pham T. Are Ultrasound Findings Similar in Patients with Axial Spondyloarthritis and in Athlete Entheses? J Rheumatol 2017; 44:609-612. [PMID: 28250140 DOI: 10.3899/jrheum.160715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Enthesitis is the spondyloarthritis (SpA) landmark, but can also be seen after entheses overuse, such as during intensive sport. METHODS We aimed to compare entheses ultrasound (US) findings in a prospective cross-sectional study of 30 axial SpA cases, 30 athletes, and 29 controls. RESULTS Mean (SD) MAdrid Sonographic Enthesis Index (MASEI) score was 26.3 (13), 12.2 (7), and 10.4 (6) in patients with SpA, athletes, and non-athlete control groups, respectively (p < 0.0001). CONCLUSION The MASEI score was significantly higher in patients with SpA compared with healthy controls, athletes, and non-athletes, and can be of value to distinguish SpA from healthy subjects, whatever their physical activity.
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Affiliation(s)
- Marie-Alix Lanfranchi
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Olivier Leluc
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Alice Tavano
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Cécile Wormser
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Sophie Morange
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Christophe Chagnaud
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Vincent Pradel
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Pierre Lafforgue
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Thao Pham
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France. .,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University.
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Kehl AS, Corr M, Weisman MH. Review: Enthesitis: New Insights Into Pathogenesis, Diagnostic Modalities, and Treatment. Arthritis Rheumatol 2016; 68:312-22. [PMID: 26473401 PMCID: PMC5195265 DOI: 10.1002/art.39458] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Amy S. Kehl
- University of California at Los Angeles, Santa Monica, California
| | - Maripat Corr
- University of California at San Diego, La Jolla, California
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General applications of ultrasound in rheumatology: why we need it in our daily practice. J Clin Rheumatol 2015; 21:133-43. [PMID: 25807093 DOI: 10.1097/rhu.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound (US) is a noninvasive imaging technique that continues to gain interest among rheumatologists because of its undoubted utility for the assessment of a wide range of abnormalities in rheumatic diseases. It also has a great potential to be used at the time of consultation as an extension of the clinical examination.Current data demonstrate that the standard clinical approach could result in an insensitive assessment of some the different aspects of the various rheumatic diseases for which US has become a feasible and effective imaging modality that allows early detection of anatomical changes, careful guidance for the aspiration and/or local treatment, and short- and long-term therapy monitoring at the joint, tendon, enthesis, nail, and skin levels. The spectrum of pathological conditions for which US plays a crucial role continues to increase over time and includes rheumatoid arthritis, spondyloarthropathies, osteoarthritis, crystal-related arthropathies, connective tissue disorders, and vasculitis.It is expected that the inclusion of more longitudinal studies with a larger number of patients and more rigorous methodological approach will undoubtedly provide a better understanding of the significance of the abnormal US findings detected in order to provide the proper diagnostic and/or therapeutic approaches. In this article, we analyze the current potential applications of US in rheumatology and discuss the evidence supporting its use in the daily rheumatologic practice.
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Ultrasound in musculoskeletal disorder – A new horizon in rheumatology. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kiltz U, Rudwaleit M, Sieper J, Krause D, Chenot JF, Stallmach A, Jaresch S, Oberschelp U, Schneider E, Swoboda B, Böhm H, Heiligenhaus A, Pleyer U, Böhncke WH, Stemmer M, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 3 Clinical symptoms]. Z Rheumatol 2014; 73 Suppl 2:28-39. [PMID: 25181971 DOI: 10.1007/s00393-014-1428-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), -, -,
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[German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 6 Diagnostics]. Z Rheumatol 2014; 73 Suppl 2:49-65. [PMID: 25181974 DOI: 10.1007/s00393-014-1431-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GAW, Filippucci E, Gandjbakhch F, Mandl P, Pineda C, Schmidt WA, D'Agostino MA. Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014; 66:741-8. [PMID: 24151222 DOI: 10.1002/acr.22191] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/24/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To standardize ultrasound (US) in enthesitis. METHODS An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability. RESULTS Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13-1. The interobserver kappa values were variable, with the lowest kappa coefficient for enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63). CONCLUSION This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.
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Affiliation(s)
- L Terslev
- Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
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Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients. Clin Rheumatol 2014; 34:125-32. [PMID: 24838482 DOI: 10.1007/s10067-014-2673-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 04/30/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
The objective of this study is to evaluate the responsiveness to therapy change of a global ultrasound (US) assessment in the short-term monitoring of spondyloarthritis (SpA) patients with peripheral involvement. Consecutive SpA patients with both clinical peripheral involvement and active disease (initiating or changing therapy) were included. All patients underwent both clinical and US assessment in day entering the study and after 3 months of follow-up. Peripheral global US assessment included the recognition of abnormal inflammatory findings at joint, tendon, and entheseal level according to standardized scanning methods. A total of 34 patients completed both basal and 3-month follow-up assessments. Acute phase reactants, both erythrocyte sedimentation rate and C-reactive protein, tenderness (68) and swollen (66) joint counts, Bath Ankylosing Spondylitis Disease Activity Index and Health Assessment Questionnaire decreased significantly at 3-month follow-up. Total score for the global US assessment also decreased significantly between basal and 3-month follow-up assessment [mean difference, 12.33 (IC 95 %, 9.23-15.42); p < 0.0001]. All individual component, joint, tendon, and enthesis scores, also showed a significant decrease during the follow-up period. A high degree of intra-observer reliability was found for the global US assessment (ICC [95 % CI]: 0.977 [0.961-0.993]). This global US assessment, including joints, tendons, and entheses, showed a good responsiveness to clinical changes and might be useful for monitoring SpA patients with peripheral involvement.
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Mera-Varela A, Ferreiro-Iglesias A, Perez-Pampin E, Porto-Silva M, Gómez-Reino JJ, Gonzalez A. Ultrasonographic assessment of enthesitis in HLA-B27 positive patients with rheumatoid arthritis, a matched case-only study. PLoS One 2013; 8:e58616. [PMID: 23505543 PMCID: PMC3591382 DOI: 10.1371/journal.pone.0058616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/05/2013] [Indexed: 01/22/2023] Open
Abstract
Introduction HLA-B27 has a modifier effect on the phenotype of multiple diseases, both associated and non-associated with it. Among these effects, an increased frequency of clinical enthesitis in patients with Rheumatoid Arthritis (RA) has been reported but never explored again. We aimed to replicate this study with a sensitive and quantitative assessment of enthesitis by using standardized ultrasonography (US). Methods The Madrid Sonography Enthesitis Index (MASEI) was applied to the US assessment of 41 HLA-B27 positive and 41 matched HLA-B27 negative patients with longstanding RA. Clinical characteristics including explorations aimed to evaluate spondyloarthrtitis and laboratory tests were also done. Results A significant degree of abnormalities in the entheses of the patients with RA were found, but the MASEI values, and each of its components including the Doppler signal, were similar in HLA-B27 positive and negative patients. An increase of the MASEI scores with age was identified. Differences in two clinical features were found: a lower prevalence of rheumatoid factor and a more common story of low back pain in the HLA-B27 positive patients than in the negative. The latter was accompanied by radiographic sacroiliitis in two HLA-B27 positive patients. No other differences were detected. Conclusion We have found that HLA-B27 positive patients with RA do not have more enthesitis as assessed with US than the patients lacking this HLA allele. However, HLA-B27 could be shaping the RA phenotype towards RF seronegativity and axial involvement.
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Affiliation(s)
- Antonio Mera-Varela
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Aida Ferreiro-Iglesias
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Eva Perez-Pampin
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Marisol Porto-Silva
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Juan J. Gómez-Reino
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Gonzalez
- Research Laboratory 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria – Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
- * E-mail:
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McAlindon T, Kissin E, Nazarian L, Ranganath V, Prakash S, Taylor M, Bannuru RR, Srinivasan S, Gogia M, McMahon MA, Grossman J, Kafaja S, FitzGerald J. American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in rheumatology clinical practice. Arthritis Care Res (Hoboken) 2013; 64:1625-40. [PMID: 23111854 DOI: 10.1002/acr.21836] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kang T, Lanni S, Nam J, Emery P, Wakefield RJ. The evolution of ultrasound in rheumatology. Ther Adv Musculoskelet Dis 2012; 4:399-411. [PMID: 23227117 DOI: 10.1177/1759720x12460116] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Musculoskeletal ultrasound is a powerful tool not only for evaluating joint and related structures but also for assessing disease activity. Ultrasound in rheumatology has rapidly evolved and been incorporated into routine clinical practice over the past decade. Moreover, technological development of equipment has made it more accessible for rheumatologists. We present a review of advances in ultrasound in rheumatology, focusing on major chronological developments.
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Affiliation(s)
- Taeyoung Kang
- Department of Rheumatology, Yonsei Univeristy Wonju College of Medicine, Wonju, Republic of Korea
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Schirmer M, Duftner C, Schmidt WA, Dejaco C. Ultrasonography in inflammatory rheumatic disease: an overview. Nat Rev Rheumatol 2011; 7:479-88. [DOI: 10.1038/nrrheum.2011.95] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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