Abstract
Objective
To evaluate the relationship between power Doppler ultrasonography (PDUS) assessment and clinical variables including enthesitis index, pain threshold and disease activity parameters, and to document grey-scale US findings of the 13 entheses examined.
Design and patients
A total of 390 entheses were examined in thirty patients with AS, and clinical variables of the Maastricht Ankylosing Spondylitis Enthesitis Index (MASES), anthropometric measurements, disease activity and functional parameters were documented. A total MASES score by palpation (t-PS) and algometric pressure pain threshold (t-PPT) was obtained. Grey scale and PDUS examination of 13 entheses were performed. Grey-scale changes such as altered tendon echogenity, calcification, cortical reactive changes and bursitis were noted, and flow on PDUS was graded semi-quantitatively.
Results
Cumulative power Doppler (t-PDS) score significantly correlated with t-PS and t-PPT. Ultimate correlations were found between power Doppler scores and pain, disease activity and disability parameters. Changes in grey scale combined with PDUS were more prevalent in lower-extremity entheses. The intraobserver agreement of flow signal grading was excellent (kappa=0.82). Clinical and sonographic results were concordant for three regions, but were discordant for four regions where tenderness was accepted as the sole clinical manifestation of enthesis.
Conclusion
Pain or tenderness is associated with increased vascularity of entheses. Power Doppler US examination of the entheses may be useful and complementary to the clinical evaluation, and further research is needed to assess its role in diagnosis and follow-up of disease course.
Similar content being viewed by others
References
McGonagle D, Khan MA, Marzo-Ortega H, O’Connor P, Gibbon W, Emery P Enthesitis in spondyloarthropathy. Curr Opin Rheumatol 1999;11:244–250
Khan MA Enthesitis: a broader definition. Ann Rheum Dis 2000;59:998
Francois RJ, Braun J, Khan MA Entheses and enthesitis : a histopathologic review and relevance to spondyloarthritides. Curr Opin Rheumatol 2001;13:255–264
Mander M, Simpson JM, McLellan A, Walker D, Goodacre JA, Dick CW Studies on an enthesis index as a method of clinical assessment in ankylosing spondylitis. Ann Rheum Dis 1987;46:197–202
Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, Landewe R, van der Tempel H, Mielants H, Daugados M, van der Heijde D Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003;62:127–132
McGonagle D, Gibbon W, O’Connor P, Green M, Pease C, Emery P Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 1998;41:694–700
Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD Ultrasonography of entheseal insertions in lower limp in spondylarthropathy. Ann Rheum Dis 2002;61:905–910
D’Agostino MA, Said-Nahal R, Hacquard-Bounder C, Brasseur JL, Daugados M, Breban M Assessment of peripheral enthesitis in spondyloarthropathies by ultrasonography combined with power Doppler. A cross-sectional study. Arthritis Rheum 2003;48:523–533
Grassi W, Cervini C Ultrasonography in rheumatology: an evolving technique. Ann Rheum Dis 1998;57:268–271
Balint P, Sturrock RD Musculoskeletal ultrasound imaging: a new diagnostic tool for the rheumatologist? Br J Rheumatol 1997;36:1141–1142
Grassi W, Flippucci E, Busilacchi P Musculoskeletal ultrasound. Best Pract Res Clin Rheumatol 2004;18:813–826
Newman JS, Adler RS, Bude RO, Rubin JM Detection of soft tissue hyperemia: value of power Doppler sonography. AJR Am J Roentgenol 1994;163:385–389
Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis. A comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001;44:2018–2023
Ozgocmen S, Kiris A, Kocakoc E, Ardicoglu O, Kamanli A Evaluation of metacarpophalangeal joint synovitis in rheumatoid arthritis by power Doppler technique: relationship between synovial vascularization and periarticular bone mineral density. Joint Bone Spine 2004;71:384–388
Schmidt WA Doppler sonography in rheumatology. Best Pract Res Clin Rheumatol 2004;18:827–846
Van der Linden S, Valkenburg HA, Cats A Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361–368
Garett SL, Jenkinson TR, Whitelock HC, Kennedy LG, Gaisford P, Calin A A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). J Rheumatol 1994;21:2286–2291
Daltroy LH, Larson MG, Roberts WN, Liang MH A modification of the health assessment questionnaire for spondyloarthropathies. J Rheumatol 1990;17:946–950
Dougados M, GueguenA, Nakache JP, Nguyen M, Mery C, Amor B Evaluation of a functional index and an articular index in ankylosing spondylitis. J Rheumatol 1988;15:302–307
Calin A, Garrett S, Whitelock H et al A new approach to defining functionalability in ankylosing spondylitis: The developmentof the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994;21:2281–2285
D’Agostino MA, Breban M, Said-Nahal R, Daugados M Refractory inflammatory heel pain in spondylarthropathy: a significant response to infliximab documented by ultrasound. Arthritis Rheum 2002;46:840–841
Ozgocmen S, Kiris A, Ardicoglu O, Kocakoc E, Kaya A Glucocorticoid iontophoresis for Achilles tendon enthesitis in ankylosing spondylitis: significant response documented by power Doppler ultrasound. Rheumatol Int 2005;25:158–160
Gibbon W, Long G Ultrasound of the plantar aponeurosis (fascia). Skelet Radiol 1999;28:21–26
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kiris, A., Kaya, A., Ozgocmen, S. et al. Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography. Skeletal Radiol 35, 522–528 (2006). https://doi.org/10.1007/s00256-005-0071-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-005-0071-3