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Yamada Y, Inui K, Mandai K, Mamoto K, Koike T, Tateishi C, Tsuruta D, Okano T. Ultrasonographic Synovitis Is Associated with the Development of Joint Destruction in Patients with Psoriatic Arthritis. J Pers Med 2024; 14:630. [PMID: 38929851 PMCID: PMC11205144 DOI: 10.3390/jpm14060630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) is characterized by enthesitis. As persistent inflammation around joints results in bone and cartilage destruction and physical impairment, a detailed assessment of inflammation is essential. We previously reported the difference between clinical assessment (tenderness) and ultrasound (US) assessment (inflammation) of entheses. Herein, we investigated whether clinical or US assessment of joints and entheses can predict the progression of joint destruction in Japanese patients with PsA. METHODS Thirty joints and 14 entheses in 47 patients were assessed using US and clinical examination. The US greyscale (GS) and power Doppler (PD) scores at the ultrasonographic synovitis, the US active enthesitis count, and the clinical tender joint/entheses count were assessed. Additionally, the yearly radiographic progression of the Sharp-van der Heijde scoring method for PsA was assessed. Their correlations were investigated. RESULTS About half of the patients with PsA experienced joint destruction during a follow-up period of 20.4 months. Progression of joint destruction in patients with PsA only correlated with joint GS and PD scores, reflecting the severity of ultrasonographic synovitis, not with the tender joint/entheses count. CONCLUSIONS US examinations are essential for preventing joint destruction and physical impairment in patients with PsA.
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Affiliation(s)
- Yutaro Yamada
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (Y.Y.); (K.I.); (K.M.)
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (Y.Y.); (K.I.); (K.M.)
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Koji Mandai
- Mikunigaoka Mandai Orthopaedic Clinic, Osaka 590-0024, Japan;
| | - Kenji Mamoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (Y.Y.); (K.I.); (K.M.)
| | - Tatsuya Koike
- Search Institute for Bone and Arthritis Disease (SINBAD), Wakayama 649-2211, Japan;
| | - Chiharu Tateishi
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (C.T.); (D.T.)
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan; (C.T.); (D.T.)
| | - Tadashi Okano
- Center for Senile Degenerative Disorders (CSDD), Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
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2
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Lin SH, Hsu CY, Li SC. Increased Circulating CD14+ Monocytes in Patients with Psoriatic Arthritis Presenting Impaired Apoptosis Activity. Biomedicines 2024; 12:775. [PMID: 38672131 PMCID: PMC11048590 DOI: 10.3390/biomedicines12040775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis primarily affecting peripheral and axial joints. The osteolytic effect in the damaged joint is mediated by osteoclast activation. We aimed to investigate differential gene expression in peripheral CD14+ monocytes between patients with psoriatic arthritis (n = 15) and healthy controls (HCs; n = 15). Circulating CD14+ monocytes were isolated from peripheral blood mononuclear cells using CD14+ magnetic beads. Cell apoptosis was measured via Annexin V using flow cytometry. The gene expression profiling was analyzed via microarray (available in the NCBI GEO database; accession number GSE261765), and the candidate genes were validated using PCR. The results showed a higher number of peripheral CD14+ monocytes in patients with PsA than in the HCs. By analyzing the microarray data, identifying the differentially expressed genes, and conducting pathway enrichment analysis, we found that the apoptosis signaling pathway in CD14+ cells was significantly impaired in patients with PsA compared to the HCs. Among the candidate genes in the apoptotic signaling pathway, the relative expression level of cathepsin L was confirmed to be significantly lower in the PsAs than in the HCs. We concluded that the numbers of peripheral CD14+ monocytes increased, and their apoptosis activity was impaired in patients with PsA, which could lead to enhanced macrophage maturation and osteoclast activation. The resistance of apoptotic death in peripheral CD14+ monocytes may contribute to active joint inflammation in PsA.
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Affiliation(s)
- Shang-Hung Lin
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- College of Medicine, National Sun Yat-sen University, No. 70, Lianhai Road, Gushan District, Kaohsiung City 804, Taiwan
| | - Chung-Yuan Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- College of Medicine, National Sun Yat-sen University, No. 70, Lianhai Road, Gushan District, Kaohsiung City 804, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Sung-Chou Li
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung 813414, Taiwan
- Department of Dental Technology, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821004, Taiwan
- Department of Nursing, Meiho University, Pingtung 912009, Taiwan
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3
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Macía-Villa C, De Miguel E. New Advances in the Knowledge of Elemental Enthesis Lesions: Doppler, Erosion, and Thickness. J Rheumatol 2023; 50:6-8. [PMID: 36455941 DOI: 10.3899/jrheum.221116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Cristina Macía-Villa
- C. Macía-Villa, MD, PhD, Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid;
| | - Eugenio De Miguel
- E. De Miguel, MD, PhD, Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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4
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Mathew AJ, Østergaard M, Eder L. Imaging in psoriatic arthritis: Status and recent advances. Best Pract Res Clin Rheumatol 2021; 35:101690. [PMID: 34016527 DOI: 10.1016/j.berh.2021.101690] [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] [Indexed: 12/15/2022]
Abstract
The heterogeneous nature of psoriatic arthritis (PsA), encompassing several domains, with varied presentations brings about considerable challenges in disease evaluation. Prompt diagnosis and targeted therapy have resulted in disease remission being accepted as an attainable goal in PsA. Imaging has played a pivotal role in early diagnosis, better understanding of pathogenesis, monitoring of disease, and as an outcome measurement tool in clinical trials in PsA. Conventional radiography has been the cornerstone of assessing structural damage. With the advent of ultrasound and magnetic resonance imaging, better delineation of the various structures involved in the disease process is possible, thus enabling sensitive assessment of inflammatory and structural pathologies together. In this review, imaging modalities used in routine assessment and clinical trials in PsA will be discussed in detail, focusing on advances over the past 5 years.
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Affiliation(s)
- Ashish J Mathew
- Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, University Hospital, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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5
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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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6
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Perez-Chada LM, Haberman RH, Chandran V, Rosen CF, Ritchlin C, Eder L, Mease P, Reddy S, Ogdie A, Merola JF, Scher JU. Consensus terminology for preclinical phases of psoriatic arthritis for use in research studies: results from a Delphi consensus study. Nat Rev Rheumatol 2021; 17:238-243. [PMID: 33589818 PMCID: PMC7997804 DOI: 10.1038/s41584-021-00578-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
The concept of psoriatic arthritis (PsA) prevention is gaining increased interest owing to the physical limitation, poor quality of life and low remission rates that are achieved with current therapies for PsA. The psoriasis-to-PsA transition offers a unique opportunity to identify individuals at increased risk of developing PsA and to implement preventive strategies. However, identifying individuals at increased risk of developing PsA is challenging as there is no consensus on how this population should be defined. This Consensus Statement puts forward recommended terminology from the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) for defining specific subgroups of individuals during the preclinical and early clinical phases of PsA to be used in research studies. Following a three-round Delphi process, consensus was reached for three terms and definitions: 'increased risk for PsA', 'psoriasis with asymptomatic synovio-entheseal imaging abnormalities' and 'psoriasis with musculoskeletal symptoms not explained by other diagnosis'. These terms and their definitions will enable improved identification and standardization of study populations in clinical research. In the future, as increasing evidence emerges regarding the molecular and clinical features of the psoriasis-to-PsA continuum, these terms and definitions will be further refined and updated.
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Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca H Haberman
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.,Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Cheryl F Rosen
- Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Christopher Ritchlin
- Allergy, Immunology, and Rheumatology Division, University of Rochester Medical School, Rochester, NY, USA
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Philip Mease
- Seattle Rheumatology Associates, Swedish Medical Center and Providence St, Joseph Health, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Soumya Reddy
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Alexis Ogdie
- Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph F Merola
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA.
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Kaeley GS. Enthesitis in psoriatic arthritis (Part 2): imaging. Rheumatology (Oxford) 2021; 59:i15-i20. [PMID: 32159789 PMCID: PMC7065457 DOI: 10.1093/rheumatology/keaa040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/02/2020] [Indexed: 01/30/2023] Open
Abstract
Enthesitis is a hallmark finding in PsA and may predate the onset of synovitis. Clinical examination of enthesitis provides no structural information, relies on eliciting tenderness at entheseal sites and may not be sensitive or specific. Soft tissue imaging techniques such as musculoskeletal ultrasound and MRI can depict ultrastructural and inflammatory changes. Although these imaging techniques are complimentary, ultrasound can image superficial entheses with high fidelity and examine vascularity with the use of Doppler but cannot image subchondral bone. MRI depicts bone and can visualize bone marrow edema as well as soft tissue edema. However, due to short relaxation times, entheseal structures are not easily differentiated. There has been increasing recognition of biomechanical confounding, especially since the majority of the entheses examined are in the lower extremity. Imaging entheseal indices are being developed to minimize the effect of body weight and activity. In the following article, contemporary concepts of entheses in relation to imaging will be reviewed as well as important confounders in assessing entheseal alterations. The role and limitations of imaging techniques will be discussed.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, FL, USA
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8
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Aydin SZ, Mathew AJ, Koppikar S, Eder L, Østergaard M. Imaging in the diagnosis and management of peripheral psoriatic arthritis. Best Pract Res Clin Rheumatol 2020; 34:101594. [PMID: 33032929 DOI: 10.1016/j.berh.2020.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Psoriatic arthritis is a heterogenous disease affecting peripheral and axial joints, tendons, ligaments, and their insertions, in addition to the skin and the nails. The complexity of the involved structures has puzzled clinicians trying to understand the underlying pathology that leads to symptoms in order to choose the appropriate medications with different modes of actions. Imaging, mainly ultrasound and magnetic resonance imaging, allows of accurate detection of inflammatory changes in the musculoskeletal structures, which helps to avoid false positive and negative assessments. The linking of different anatomical structures' involvement using imaging also provides insights into the pathogenesis of psoriatic arthritis. In this review, ultrasound and magnetic resonance imaging will be discussed in depth with regard to their use in the field of peripheral psoriatic arthritis, with a focus on the literature from the last 4 years and recent advances.
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Affiliation(s)
- Sibel Zehra Aydin
- University of Ottawa Faculty of Medicine, Rheumatology, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Ashish J Mathew
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.
| | - Sahil Koppikar
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Lihi Eder
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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9
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Abstract
PURPOSE OF REVIEW Enthesitis is a hallmark feature of the spondyloarthropathies (SpA). This review provides an overview of recent insights on diagnosis and management of enthesitis. RECENT FINDINGS Recent studies support the use of imaging for diagnosis because of its higher sensitivity and specificity compared with clinical examination. Several new MRI and ultrasound scoring systems have been developed for enthesitis, which may facilitate the use of imaging in research. Enthesitis has been evaluated as a primary study outcome mainly in psoriatic arthritis (PsA); however, the use of different indices and definitions of improvement limits comparison across studies. There is very limited information about the efficacy of synthetic disease modifying antirheumatic drugs (DMARDs) for the treatment of enthesitis. In contrast, targeted and biologic DMARDs have all shown efficacy in treating enthesitis compared with placebo. There have been only a few head-to-head trials that compared two different cytokine inhibitors for the treatment of enthesitis. Preliminary data suggest that targeting IL-17 or IL12/23 may be more efficacious for controlling enthesitis than TNF inhibition. SUMMARY Emerging data suggest interleukin-17 and 12/23 inhibitors may be the first choice in PsA patients with enthesitis. Further head-to-head studies are needed before making definitive recommendations.
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Affiliation(s)
- Sahil Koppikar
- Division of Rheumatology, Women's College Hospital.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bakewell C, Aydin SZ, Ranganath VK, Eder L, Kaeley GS. Imaging Techniques: Options for the Diagnosis and Monitoring of Treatment of Enthesitis in Psoriatic Arthritis. J Rheumatol 2019; 47:973-982. [PMID: 31676700 DOI: 10.3899/jrheum.190512] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 02/08/2023]
Abstract
Psoriatic arthritis (PsA) affects up to 30% of patients with psoriasis and may include musculoskeletal manifestations such as enthesitis. Enthesitis is associated with joint damage, and early detection and treatment are essential to management of the disease. Traditionally assessed by clinical examination and conventional radiography, entheseal inflammation can now be more accurately assessed earlier in the disease using techniques such as ultrasound, magnetic resonance imaging, computed tomography, and molecular imaging. However, there is little consensus on the optimum definition for diagnosing enthesitis in PsA or on the ideal scoring system for measuring response to treatment. This review aims to summarize the benefits and limitations of different imaging modalities in the assessment of enthesitis. It also proposes that adoption of standardized definitions and validation of scoring systems and imaging techniques in clinical trials will allow the efficacy of new treatment options to be assessed more accurately.
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Affiliation(s)
- Catherine Bakewell
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA. .,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis. .,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine.
| | - Sibel Zehra Aydin
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
| | - Veena K Ranganath
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
| | - Lihi Eder
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
| | - Gurjit S Kaeley
- From the Intermountain Healthcare Medical Group, Salt Lake City, Utah, USA; University of Ottawa, Ottawa, Ontario, Canada; University of California, Los Angeles (UCLA), California, USA; Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; University of Florida College of Medicine, Jacksonville, Florida, USA.,C. Bakewell has received consultancy fees from and/or served on speakers bureaus for AbbVie and Novartis Pharmaceuticals Corp. S.Z. Aydin has received honoraria from Novartis. V.K. Ranganath has served on the Data and Safety Monitoring Board for Amgen and has received grants for investigator-initiated studies from Mallinckrodt. L. Eder has received research or educational grants and/or consultancy fees from Novartis. G.S. Kaeley has received consultancy fees from Novartis.,C. Bakewell, MD, Rheumatologist, Intermountain Healthcare Medical Group Salt Lake Clinic; S.Z. Aydin, MD, Associate Professor in Rheumatology, University of Ottawa, Ottawa Hospital Research Institute; V.K. Ranganath, MD, MS, Health Sciences Associate Clinical Professor, Division of Rheumatology, David Geffen School of Medicine at UCLA; L. Eder, MD, PhD, Assistant Professor of Medicine, Women's College Research Institute, Women's College Hospital, University of Toronto; G.S. Kaeley, MBBS, MRCP, RhMSUS, Professor, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine
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11
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Macía-Villa C, Falcao S, Medina J, De Miguel E. Ultrasonography of enthesis in psoriatic arthritis: a descriptive and reliability analysis of elemental lesions and power Doppler subtypes. Scand J Rheumatol 2019; 48:454-459. [PMID: 31210075 DOI: 10.1080/03009742.2019.1602881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Macía-Villa
- Department of Rheumatology, Severo Ochoa University Hospital, Madrid, Spain
| | - S Falcao
- Department of Rheumatology, Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL; HEM, West Lisbon Hospital Center, Lisbon, Portugal
| | - J Medina
- Department of Rheumatology, Clínico University Hospital, Valladolid, Spain
| | - E De Miguel
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
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12
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Tom S, Zhong Y, Cook R, Aydin SZ, Kaeley G, Eder L. Development of a Preliminary Ultrasonographic Enthesitis Score in Psoriatic Arthritis - GRAPPA Ultrasound Working Group. J Rheumatol 2018; 46:384-390. [PMID: 30323008 DOI: 10.3899/jrheum.171465] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the performance of various sonographic elemental entheseal lesions in distinguishing between psoriatic arthritis (PsA) and controls to inform the development of a novel sonographic enthesitis score for PsA. METHODS A total of 100 age- and sex-matched individuals (50 PsA and 50 controls) were evaluated. Eleven entheseal sites were scanned bilaterally according to a standardized protocol by 2 sonographers. Based on the Outcome Measures in Rheumatology (OMERACT) definition of sonographic enthesitis, the following lesions were assessed: structural entheseal changes (hypoechogenicity), thickening, bone erosion, enthesophytes, calcification, and Doppler signal, in addition to bursitis and bone irregularities. The images were read by 2 readers blinded to the clinical information. A series of logistic regression models were used to find the optimal combination of entheseal sites and elementary lesions that distinguished PsA from controls. RESULTS Mean age was 55 ± 10 years (59% males). The optimal model that distinguished PsA from controls included 5 elementary lesions (enthesophytes, Doppler signal, erosions, thickening, and hypoechogenicity) and 6 entheseal sites (patellar ligament insertions into the distal patella and tibial tuberosity, Achilles tendon and plantar fascia insertions into the calcaneus, common extensor tendon insertion into lateral epicondyle, and supraspinatus insertion into the superior facet of the humerus). The area under the receiver-operating characteristic curve for this model was 0.93 (95% CI 0.88-0.98). CONCLUSION We identified potential elemental ultrasonographic abnormalities and entheseal sites that could distinguish PsA and controls. This information will contribute to the development of a new sonographic score for assessment of enthesitis in patients with PsA.
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Affiliation(s)
- Stephanie Tom
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Yujie Zhong
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Richard Cook
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Sibel Zehra Aydin
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Gurjit Kaeley
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA.,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto
| | - Lihi Eder
- From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA. .,S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto.
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