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The identification of association between ultrasonographic enthesitis and the ASAS Health Index in patients with axial spondyloarthritis

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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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Authors and Affiliations

  1. Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Ibni Sina Hospital, Ankara University, 4th Floor, Altındağ, Ankara, Turkey

    Abdulvahap Kahveci, Alper Gümüştepe & Şebnem Ataman

  2. Department of Physical Medicine and Rehabilitation, School of Medicine, Ankara University, Ankara, Turkey

    Yuzlem Gyuner Sıdzhımlı & Seçilay Güneş

  3. Department of Public Health, School of Medicine, İzmir Democracy University, İzmir, Turkey

    Caner Baysan

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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by KA, OYG, GA, and GS. Statistical analysis was performed by BC. The first draft of the manuscript was written by KA. All authors commented on previous versions of the manuscript. All co-authors read and approved the final manuscript.

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Correspondence to Abdulvahap Kahveci.

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All authors have no conflict of interest.

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During the study, the World Medical Association Helsinki Declaration and Good Clinical Practices Guidelines were followed. This study was approved by the local ethics committee (Protocol number: İ9-559-20). Reporting of this trial was conducted according to the STROBE (Strengthening the reporting of observational studies in epidemiology) checklist. This study has been presented as an oral presentation at the Turkish League against Rheumatism (TLAR) 2021 congress and has been selected as the second-best study.

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Kahveci, A., Sıdzhımlı, Y.G., Güneş, S. et al. The identification of association between ultrasonographic enthesitis and the ASAS Health Index in patients with axial spondyloarthritis. Rheumatol Int 43, 99–107 (2023). https://doi.org/10.1007/s00296-022-05188-z

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