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Bonfiglioli KR, Lopes FODA, de Figueiredo LQ, Ferrari LFF, Guedes L. Ultrasonographic Insights into Peripheral Psoriatic Arthritis: Updates in Diagnosis and Monitoring. J Pers Med 2024; 14:550. [PMID: 38929771 PMCID: PMC11205202 DOI: 10.3390/jpm14060550] [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: 04/22/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, characterized by heterogeneous clinical manifestations and variable disease progression. Ultrasonography has emerged as a valuable tool in the diagnosis and monitoring of PsA, providing real-time visualization of joint and soft tissue abnormalities. This review highlights recent advancements in ultrasonographic techniques for the assessment of PsA, including the identification of typical features, the role of power Doppler imaging in detecting active inflammation, and the potential of ultrasound for guiding treatment decisions. Additionally, we discuss the utility of ultrasound in assessing treatment response and monitoring disease progression in patients with PsA, with a focus on novel imaging modalities. By elucidating the evolving role of ultrasonography in PsA management, this article aims to enhance clinicians' understanding of its utility in facilitating early diagnosis, optimizing treatment strategies, and improving patient outcomes.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Reumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil; (F.O.d.A.L.); (L.Q.d.F.); (L.F.F.F.); (L.G.)
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Xie H, Zhou G, Luo H, Zhao C, Zhang Y, Dong Q, Lv H, Zhong J, Lv J, Zhang W, Sun D, Wang Q, Liu L. Ultrasound Assessment of Entheseal Sites and Anterior Chest Wall in Ankylosing Spondylitis: A Cross-Sectional Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2535-2545. [PMID: 37357887 DOI: 10.1002/jum.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES The study was designed to evaluate entheseal sites and anterior chest wall (ACW) of patients with ankylosing spondylitis (AS) using ultrasound (US) and investigate the correlation between disease activity and US score. METHODS This prospective cross-sectional study included 104 patients with AS and 50 control subjects. Each patient underwent US scanning of 23 entheses and 11 sites of the ACW. The US features, including hypoechogenicity, thickness, erosion, calcification, bursitis, and Doppler signal, were evaluated. Disease activity was assessed based on C reactive protein (CRP), erythrocyte sedimentation rate (ESR), disease activity score-C reactive protein (ASDAS-CRP), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). RESULTS The most commonly involved entheses on US were the Achilles tendon (AT) and quadriceps tendon (QT). The most involved site of ACW was the sternoclavicular joint (SCJ). Compared with the control group, significant differences were observed in the AS group in the rates of US enthesitis and ACW in AT (P = .01), SCJ (P = .00), and costochondral joint (CCJ) (P = .01). Patients with high or very high disease activity had a higher erosion score (P = .02). The erosion score was weakly positively associated with CRP, ESR, BASDAI, ASDAS-CRP, and ASDAS-ESR (correlation coefficient: 0.22-0.45). CONCLUSIONS The most commonly involved entheseal sites on US were AT and QT, while the site of ACW was SCJ. The US assessment of AS should take the ACW into account. High disease activity might indicate erosion in AS.
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Affiliation(s)
- Haiqin Xie
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Gengmin Zhou
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haiyu Luo
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chenyang Zhao
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yusen Zhang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qian Dong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Heng Lv
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jianqiu Zhong
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jiyang Lv
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Weiwei Zhang
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qingwen Wang
- Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China
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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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Wu X, Liu D, Li Y, Xie Y, Tu L, Zhang Y, Zhang X, Fang L, Luo X, Lin Z, Liao Z, Rong L, Ren J, Zhou Y, Yang N, Xu J, Zhang H, Xu B, Wu Z, Zhan F, Li Z, Xiao W, Liu S, Zhou Y, Ye S, Lv Q, Zhang L, Zhao D, He S, Zhao L, Wu L, Lin H, Zhu Y, Guo D, Yang Z, Liu B, Yang K, Gu J. A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis. Front Immunol 2022; 13:978504. [PMID: 36172360 PMCID: PMC9510351 DOI: 10.3389/fimmu.2022.978504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this review is to provide guidance on the selection of approaches to the screening and assessment of enthesitis in patients with spondyloarthritis (SpA). Methods Twenty-four questions regarding the approaches to the screening and assessment of enthesitis and the implementation details were devised, followed by a systemic literature review. The Grading of Recommendations Assessment, Development, and Evaluation methodology was employed in the development of this guideline, with modifications to evaluate non-interventional approaches under comprehensive consideration of costs, accessibility, and evidence strength. A consensus from the voting panel was required for the inclusion of the final recommendations and the strength of each recommendation. Results Seventeen recommendations (including five strong recommendations) were included in this guideline. The voting panel expressed unequivocal support for the necessity of screening and assessment of enthesitis in patients with SpA. It was agreed unanimously that symptom evaluation and physical examination should serve as the initial steps to the recognition of enthesitis, whereas Maastricht Ankylosing Spondylitis Enthesitis Score is a reliable tool in both clinical trials and daily medical practice. Ultrasound examination is another reliable tool, with power Doppler ultrasound as an informative addition. Notwithstanding its high resolution, MRI is limited by the costs and relatively low accessibility, whereas radiographs had low sensitivity and therefore should be rendered obsolete in the assessment of enthesitis. PET/CT was strongly opposed in the detection of enthesitis. Conclusion This guideline provides clinicians with information regarding the screening and assessment of enthesitis in patients with SpA. However, this guideline does not intend on dictating choices, and the ultimate decisions should be made in light of the actual circumstances of the facilities.
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Affiliation(s)
- Xinyu Wu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dong Liu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ya Xie
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liudan Tu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanli Zhang
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Zhang
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Linkai Fang
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiqing Luo
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhiming Lin
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zetao Liao
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuqi Zhou
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou>, China
| | - Niansheng Yang
- Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Xu
- Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hua Zhang
- Department of Rheumatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Baijie Xu
- Department of Rheumatology, Jieyang People's Hospital, Jieyang, China
| | - Zhenbiao Wu
- Department of Rheumatology, Tangdu Hospital of Air Force Military Medical University, Xian, China
| | - Feng Zhan
- Department of Rheumatology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhenbin Li
- Department of Rheumatology, Bethune International Peace Hospital, People's Liberation Army, Shijiazhuang, China
| | - Weiguo Xiao
- Department of Rheumatology, The First Hospital of China Medical University, Shenyang, China
| | - Shengyun Liu
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Zhou
- Department of Rheumatology and Immunology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shanhui Ye
- Department of Rheumatology and Immunology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qing Lv
- Department of Rheumatology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Lijun Zhang
- Department of Rheumatology, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
| | - Dongbao Zhao
- Department of Rheumatology and Immunology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shanzhi He
- Department of Rheumatology, Zhongshan People's Hospital, Zhongshan, China
| | - Like Zhao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, The People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - He Lin
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
| | - Yunxiao Zhu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Donggeng Guo
- Department of Rheumatology and Immunology, Ningxia Clinical Institute of Bone and Joint Research, The Affiliated People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China
| | - Zehong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Budian Liu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jieruo Gu
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic Arthritis, the Sonographic Perspective. Curr Rheumatol Rep 2021; 23:75. [PMID: 34427783 PMCID: PMC8384799 DOI: 10.1007/s11926-021-01039-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
Purpose of Review To provide an overview of the ultrasound (US) studies focusing on enthesitis in psoriatic arthritis (PsA). Recent Findings Last-generation US equipment has demonstrated the ability to detect subtle morphostructural and vascular abnormalities at entheseal level. US is able to identify pathologic changes in both “classical” (i.e., the site of attachment of tendons, ligaments, and joint capsules into the bone) and “functional” entheses (i.e., anatomical regions where tendons or ligaments wrap around bony pulleys). Summary US has the potential to be the first-line method in the assessment of enthesitis. In the present review we critically discussed the current definitions of US enthesitis, the scoring systems, and the main fields of application (i.e., the detection of enthesitis in PsA and psoriasis, the identification of different disease subsets, and the assessment of response to treatment).
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Via Aldo Moro 25, 60035 Jesi, Ancona, Italy
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McGonagle D, Aydin SZ, Marzo-Ortega H, Eder L, Ciurtin C. Hidden in plain sight: Is there a crucial role for enthesitis assessment in the treatment and monitoring of axial spondyloarthritis? Semin Arthritis Rheum 2021; 51:1147-1161. [PMID: 34537464 DOI: 10.1016/j.semarthrit.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To review the evidence surrounding the pathophysiology of enthesitis in axial spondyloarthritis (axSpA), its prevalence and contribution to the overall disease burden, and response to treatment at axial and peripheral sites. METHODS Literature searches of the Cochrane Library, PubMed, and Embase / Medline using the terms "enthesitis", "enthesopathy", "spondyloarthritis", "axial spondyloarthritis", and "ankylosing spondylitis" were conducted. Publications mentioning enthesitis or enthesopathy in the context of pathophysiology, diagnosis, or treatment were included. RESULTS Enthesitis is a common symptom of axSpA, occurring with high prevalence at axial and several peripheral sites. Inflammation at the site of enthesis is an early key manifestation of axSpA. Clinically evaluable enthesitis contributes significantly to the burden of disease, correlating with worse symptomatology and downstream structural damage. Despite its importance in driving axSpA disease processes, enthesitis is somewhat neglected in current approaches to disease assessment and management. Enthesitis is excluded from some commonly used disease activity measures, is not routinely assessed in clinical practice, and many methods of clinical assessment omit key accessible axial sites, such as the spinous processes. CONCLUSION Enthesitis plays a central role in driving the pathophysiology of axSpA. There is a need for a renewed focus on the early detection, measurement and treatment of enthesitis.
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Affiliation(s)
- Dennis McGonagle
- The Leeds Institute of the Rheumatic and Musculoskeletal Disease, University of Leeds, Chapeltown Road, Leeds LS7 4SA, United Kingdom; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom.
| | - Sibel Z Aydin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Helena Marzo-Ortega
- The Leeds Institute of the Rheumatic and Musculoskeletal Disease, University of Leeds, Chapeltown Road, Leeds LS7 4SA, United Kingdom; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Lihi Eder
- Division of Rheumatology, Department of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto, Canada
| | - Coziana Ciurtin
- Department of Rheumatology, Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, Rayne Building, London, United Kingdom
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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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Falsetti P, Conticini E, Mazzei MA, Baldi C, Sota J, Bardelli M, Gentileschi S, D'Alessandro R, Al Khayyat SG, Acciai C, Cantarini L, Frediani B. Power and spectral Doppler ultrasound in suspected active sacroiliitis: a comparison with magnetic resonance imaging as gold standard. Rheumatology (Oxford) 2021; 60:1338-1345. [PMID: 32944757 DOI: 10.1093/rheumatology/keaa546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The objectives of this study were to study with Power Doppler US (PDUS) the SI joints (SIJs) of patients with suspected active sacroiliitis, to describe SIJ flows with spectral wave analysis (SWA) on Doppler US, and to correlate US data with both clinical characteristics and presence of SIJ bone marrow oedema (BME) in subsequent MRI. METHODS A total of 42 patients (32 females and 10 males, mean age 46.8 years) with recent onset of inflammatory back pain (IBP) were included. Every patient underwent US examination with a convex 1-8 MHz probe [scoring PDUS signals with a three-point scale and describing flows in SWA calculating the mean Resistive Index (RI)] and subsequent MRI of the SIJs. RESULTS PDUS signals were detected in 34 patients and 62 SIJs. In 29 patients and 56 SIJs, MRI revealed BME. A definite diagnosis of SpA was made in 32 patients. PDUS signals were more frequent (P < 0.0001) in patients with a final diagnosis of SpA, yielding a higher PDUS score (P = 0.0304). PDUS grading correlated with both BME grading (r = 0.740, P = 0.0001) and AS DAS (ASDAS) (r = 0.6257, P = 0.0004), but not with inflammatory reactants nor anthropometric data. Mean RI were, respectively, 0.60 and 0.73 (P < 0.0001) in patients with or without diagnosis of active sacroiliitis. The most inclusive RI cut-off resulted <0.70 [positive predictive value (PPV) 94%, accuracy 90%, P = 0.0001]. The best Likelihood Ratio (5.471) for RI to detect pathologic cases was obtained with a cut-off of <0.60 (PPV 96%). CONCLUSIONS PDUS and SWA of SIJs demonstrate good diagnostic accuracy for active sacroiliitis compared with MRI.
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Affiliation(s)
- Paolo Falsetti
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Edoardo Conticini
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neurosciences, Diagnostic Imaging, University of Siena, Arezzo, Italy
| | - Caterina Baldi
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Jurgen Sota
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Marco Bardelli
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Stefano Gentileschi
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Roberto D'Alessandro
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | | | | | - Luca Cantarini
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
| | - Bruno Frediani
- Department of Medical, Surgical and Neurosciences, Rheumatology Unit, Arezzo, Italy
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Kaeley GS. Visualization of Enthesitis by Ultrasound: a Key Diagnostic Tool in Spondyloarthropathy Diagnosis and Management. Curr Rheumatol Rep 2020; 22:48. [PMID: 32696194 DOI: 10.1007/s11926-020-00927-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to report on the current status of evaluation of enthesitis with sonography. Sonography can visualize peripheral entheses in great detail since most of them are superficial. Visualization of entheses has provided insights into the pathophysiology of enthesitis and highlighted the interconnectivity of stress dissipation mechanisms about the enthesis. The primary use of entheseal sonography presently revolves around diagnostic use. RECENT FINDINGS There is increasing awareness of biomechanical confounders that lead to entheseal changes, which are more prevalent in males, patients with higher body mass index, and those who are more active-though there are several approaches to mitigate biomechanical confounders in sonographic evaluation. Entheseal sonography may also provide prognostic information in predicting the severity of axial syndesmophyte formation. Although entheseal outcome scoring systems are available, there is sparse data on its use as an outcome tool, and hence, this is a fertile area for future research.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, 653-1 West Eight Street, LRC 2nd Floor L-14, Jacksonville, FL, 32209-6561, USA.
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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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11
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Psoriasis is an independent risk factor for entheseal damage in axial spondyloarthritis. Semin Arthritis Rheum 2020; 50:42-47. [DOI: 10.1016/j.semarthrit.2019.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/24/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022]
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12
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Vahidfar S, Sunar İ, Ataman Ş, Yılmaz G, Azarabadi JM, Bölükbaşı A. Ultrasonographic evaluation of Achilles tendon: Is there any difference between ankylosing spondylitis, non-radiographic axial spondyloarthropathy and controls? Int J Rheum Dis 2020; 23:511-519. [PMID: 31985181 DOI: 10.1111/1756-185x.13796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 12/29/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim is to evaluate Achilles tendon enthesopathy with ultrasound (US) in ankylosing spondylitis (AS) and non-radiographic axial SpA (nr-axSpA) patients and controls, and compare these groups in terms of associations between disease activity parameters and ultrasonographic Achilles enthesitis signs. METHODS A total of 24 AS and 20 nr-axSpA patients fulfilling the Assessment in Spondyloarthritis International Working Group criteria for axSpA and 30 controls were enrolled. Demographic characteristics, erythrocyte sedimentation rate, C-reactive protein (CRP), human leukocyte antigen (HLA)-B27, Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index, Maastricht AS Enthesitis Score (MASES), AS Disease Activity Score-CRP, modified Stoke AS Spine Score (m-SASSS) scores and ultrasonographic findings were noted. RESULTS HLA-B27 positivity, extra-articular and peripheral involvement, disease activity, functional status, mean m-SASSS, ultrasonographic gray scale (GS) and total scores were similar between AS and nr-axSpA groups. In GS, tendon echotexture scores were significantly different across all groups (0.812 ± 0.384 in AS, 0.575 ± 0.466 in nr-axSpA, 0.017 ± 0.091 in controls; P < .001). Entheseal calcification scores were similar in AS and nr-axSpA patients, and higher than controls (P = .001). Bone profile scores were similar in patients with AS and nr-axSpA, and higher than controls (P = .010). When the correlations between US findings and disease activity and functional status were considered, power Doppler US (PDUS) and MASES total scores were positively correlated in the AS group (P = .045; r = .41). CONCLUSION AS and nr-axSpA patients were found to be similar in various clinical, functional, and US findings indicating that these 2 entities are different phenotypic reflections of the same disease spectrum. The positive correlation between PDUS and MASES scores in AS patients substantiate the performance of MASES in evaluation of entheseal activity.
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Affiliation(s)
- Shahla Vahidfar
- Department of PRM, Ankara University School of Medicine, Ankara, Turkey
| | - İsmihan Sunar
- Rheumatology Department, Department of PRM, Ankara University School of Medicine, Ankara, Turkey
| | - Şebnem Ataman
- Rheumatology Department, Department of PRM, Ankara University School of Medicine, Ankara, Turkey
| | - Gürkan Yılmaz
- Rheumatology Department, Department of PRM, Ankara University School of Medicine, Ankara, Turkey
| | - Javid M Azarabadi
- Department of Orthopaedia, Başkent University School of Medicine, Başkent, Turkey
| | - Ayşe Bölükbaşı
- Department of PRM, Ankara University School of Medicine, Ankara, Turkey
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13
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Connor DE, Paulus JA, Dabestani PJ, Thankam FK, Dilisio MF, Gross RM, Agrawal DK. Therapeutic potential of exosomes in rotator cuff tendon healing. J Bone Miner Metab 2019; 37:759-767. [PMID: 31154535 PMCID: PMC6830879 DOI: 10.1007/s00774-019-01013-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/25/2019] [Indexed: 02/07/2023]
Abstract
Rotator cuff tears are common musculoskeletal injuries that can cause significant pain and disability. While the clinical results of rotator cuff repair can be good, failure of tendon healing remains a significant problem. Molecular mechanisms underlying structural failure following surgical repair remain unclear. Histologically, enhanced inflammation, disorganization of the collagen fibers, calcification, apoptosis and tissue necrosis affect the normal healing process. Mesenchymal stem cells (MSCs) have the ability to provide improved healing following rotator cuff repair via the release of mediators from secreted 30-100 nm extracellular vesicles called exosomes. They carry regulatory proteins, mRNA and miRNA and have the ability to increase collagen synthesis and angiogenesis through increased expression of mRNA and release of proangiogenic factors and regulatory proteins that play a major role in proper tissue remodeling and preventing extracellular matrix degradation. Various studies have shown the effect of exosomes on improving outcome of cutaneous wound healing, scar tissue formation, degenerative bone disease and Duchenne Muscular Dystrophy. In this article, we critically reviewed the potential role of exosomes in tendon regeneration and propose the novel use of exosomes alone or seeded onto biomaterial matrices to stimulate secretion of favorable cellular factors in accelerating the healing response following rotator cuff repair.
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Affiliation(s)
- Denton E Connor
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Jordan A Paulus
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Parinaz Jila Dabestani
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Finosh K Thankam
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Matthew F Dilisio
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA
- Department of Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - R Michael Gross
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA
- Department of Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA.
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14
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Metabolites of type I, II, III, and IV collagen may serve as markers of disease activity in axial spondyloarthritis. Sci Rep 2019; 9:11218. [PMID: 31375691 PMCID: PMC6677742 DOI: 10.1038/s41598-019-47502-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/12/2019] [Indexed: 12/26/2022] Open
Abstract
Local inflammation in axial spondyloarthritis (axSpA) leads to the release of collagen metabolites from the disease-affected tissue. We investigated whether collagen metabolites were associated with disease activity and could distinguish non-radiographic(nr)-axSpA from ankylosing spondylitis (AS). A total of 193 axSpA patients (nr-axSpA, n = 121 and AS, n = 72) and asymptomatic controls (n = 100) were included. Serum levels of metalloproteinase (MMP)-degraded collagen type I (C1M), type II (C2M), type III (C3M) and type IV (C4M2) were quantified by enzyme-linked immunosorbent assay (ELISA). All metabolites were higher in axSpA than in controls (all p < 0.001). Serum levels of C1M, C3M, and C4M2 were increased in AS compared to nr-axSpA (43.4 ng/mL vs. 34.6; p < 0.001, 15.4 vs. 12.8; p = 0.001, and 27.8 vs. 22.4; p < 0.001). The best metabolite to differentiate between axSpA and controls was C3M (AUC 0.95; specificity 92.0, sensitivity 83.4). C1M correlated with ASDAS-CRP in nr-axSpA (ρ = 0.37; p < 0.001) and AS (ρ = 0.57; p < 0.001). C1M, C3M, and C4M2 were associated with ASDAS-CRP in AS and nr-axSpA after adjustment for age, gender, and disease duration. Serum levels of collagen metabolites were significantly higher in AS and nr-axSpA than in controls. Moreover, the present study indicates that collagen metabolites reflect disease activity and are useful biomarkers of axSpA.
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Poulain C, D'Agostino MA, Thibault S, Daures JP, Ferkal S, Le Corvoisier P, Rahmouni A, Loeuille D, Dougados M, Claudepierre P. Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort. RMD Open 2018; 4:e000686. [PMID: 30167327 PMCID: PMC6112385 DOI: 10.1136/rmdopen-2018-000686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 01/19/2023] Open
Abstract
Early diagnosis of axial spondyloarthritis (axSpA) remains a challenge due to the lack of specificity of clinical symptoms and variable prevalence of axial imaging findings permitting a definite diagnosis. Power Doppler ultrasonography (PDUS) of the entheses has demonstrated to be a potential useful tool for the classification and diagnostic management of early SpA independently of the phenotype.
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Affiliation(s)
- Cecile Poulain
- Department of Rheumatology, Hôpital Henri Mondor, APHP, Créteil, France
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Versailles, France
| | - Severine Thibault
- Equipe EA2415: Aide à la décision médicale personnalisée, Université Montpellier I, Languedoc Mutualité Nouvelle Technologie, Montpellier, France
| | - Jean Pierre Daures
- Equipe EA2415: Aide à la décision médicale personnalisée, Université Montpellier I, Languedoc Mutualité Nouvelle Technologie, Montpellier, France
| | - Salah Ferkal
- INSERM, CIC 1430, Clinical Investigation Center, Créteil, France
| | | | - Alain Rahmouni
- Department of Radiology, Hôpital Henri Mondor, APHP, Créteil, France
| | - Damien Loeuille
- Department of Rheumatology, Hôpital Nancy Brabois, Nancy, France
| | - Maxime Dougados
- Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Paris, France.,Assistance Publique, INSERM U1153, Clinical Epidemiology and Biostatistics, Hôpitaux de Paris, Paris, France
| | - Pascal Claudepierre
- Department of Rheumatology, Hôpital Henri Mondor, APHP, Créteil, France.,Université Paris Est Créteil, EA 7379 - EpidermE, Créteil, France
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