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Doppler enthesitis: a potential useful outcome in the assessment of axial spondyloarthritis and psoriatic arthritis

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Abstract

Objective

To analyse the frequency of power Doppler (PD) enthesitis in active axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients and its potential usefulness in clinical practice.

Methods

A prospective multicentre cross-sectional study in patients with axSpA and PsA with active disease was undertaken. Patients underwent bilateral ultrasound (US) examination of the peripheral entheses according to the Madrid Sonographic Enthesis Index (MASEI). The MASEI and Outcome Measures in Rheumatology (OMERACT) PD enthesitis definitions were checked. An inter-reader analysis of recorded videos was performed to determine reliability.

Results

Sixty-four consecutive patients were included. The mean DAS28 (3.9 ± 1.3) for peripheral involvement, mean BASDAI (5.6 ± 2.2) for axial involvement, and CRP values (10 ± 10.9) reflected moderate-high disease activity at baseline. The mean global MASEI score was 29.4 (± 11.4), and 55 patients (86%) scored ≥ 18 (proposed cut-off point to diagnose SpA). At the patient level, abnormal US findings consistent with at least one enthesis showing a PD signal were observed in 52 (81.3%) patients using the MASEI PD definition and 48 (75%) using the OMERACT PD definition, without significant variation between axSpA and PsA. The inter-reader reliability was excellent (kappa = 0.92 for MASEI PD and 0.86 for OMERACT PD).

Conclusions

PD enthesitis was found in the majority of patients with active axSpA and PsA, independent of axial or peripheral affectation. Both MASEI and OMERACT PD definitions were useful in detecting active enthesitis. These findings support the usefulness of a PD US evaluation of entheses in the assessment of axSpA and PsA.

Key Points

• PD enthesitis is a very common finding in patients with active axSpA and PsA

• Both MASEI and OMERACT PD definitions are useful to detect active enthesitis

• US enthesitis may reveal information in axSpA and PsA

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Acknowledgements

The authors acknowledge and thank the contribution of the subjects who participated in this study.

Contributors

Study design was performed by JMC and EDM. Subject recruitment and US examination were performed by JMC. Reliability analysis was performed by JMC, CMV and EDM. CPR collected the epidemiological and clinical data. JMC and EDM performed the statistical analysis. JMC, CMV, CPR, JAG and EDM drafted the manuscript. All co-authors revised the final manuscript.

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Authors and Affiliations

  1. Department of Rheumatology, Gregorio Marañón University Hospital, Madrid, Spain

    Juan Molina Collada & José María Álvaro-Gracia

  2. Department of Rheumatology, Severo Ochoa University Hospital, Madrid, Spain

    Cristina Macía-Villa

  3. Department of Rheumatology, La Paz University Hospital, Madrid, Spain

    Chamaida Plasencia & Eugenio de Miguel

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  1. Juan Molina Collada
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  2. Cristina Macía-Villa
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  3. Chamaida Plasencia
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  4. José María Álvaro-Gracia
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  5. Eugenio de Miguel
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Correspondence to Juan Molina Collada.

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The research protocol have been approved by the Research ethical Committee of Hospital Universitatrio La Paz and Hospital Clínico Universitario de Valladolid, and all patients gave informed written consent for their participation in the study.

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Molina Collada, J., Macía-Villa, C., Plasencia, C. et al. Doppler enthesitis: a potential useful outcome in the assessment of axial spondyloarthritis and psoriatic arthritis. Clin Rheumatol 40, 2013–2020 (2021). https://doi.org/10.1007/s10067-020-05450-4

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  • DOI: https://doi.org/10.1007/s10067-020-05450-4

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