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Construct validity and sensitivity to change of Belgrade Ultrasound Enthesitis Score in patients with spondyloarthritis: a pilot study

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Abstract

The objective of this study was to determine the construct validity and sensitivity to change of Belgrade Ultrasound Enthesitis Score (BUSES) in spondyloarthritis patients. Seventy-six spondyloarthritis patients with enthesitis were included in this pilot, prospective, double-blinded ultrasound study. Thirty-four patients received biological and forty-two patients received non-biological therapy. BUSES was determined at the beginning, after 1, 3, and 6 months. Spearman’s correlation coefficient was calculated between BUSES and baseline characteristics. Brunner–Langer mixed non-parametric ANOVA was used to examine sensitivity to change of BUSES and effect of biological therapy on BUSES. Effect of time on the presence of each of the ultrasound enthesitis signs (increased thickness, hypoehogenicity, Power Doppler, enthesophytes, and erosions) was assessed using Cochran Q test. There was a weak, positive correlation between BUSES and disease duration, clinical enthesitis score, BASFI, BASDAI, and ASDAS-ESR/CRP. BUSES was higher at the beginning than after 1 month (p = 0.004), after 3 months (p < 0.001) and after 6 months (p < 0.001), as well as BUSES was higher after 1 month than after 3 months (p < 0.001) and after 6 months (p = 0.002). There is no difference in efficiency between non-biological and biological therapies on BUSES. Increased thickness, hypoechogenicity, and Power Doppler have decreased on Achilles tendon’s and plantar fascia’s enthesis over time. BUSES has a certain degree of construct validity because of the weak, positive correlation with parameters referring to severity of spondyloarthritis. BUSES demonstrated sensitivity to change over time due to decreasing of ultrasound acute enthesitis signs in treated spondyloarthritis patients. BUSES could be useful for monitoring the progression of enthesitis and effectiveness of the treatment.

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Authors and Affiliations

  1. Institute of Rheumatology, University of Belgrade Medical School, Resavska 69, Belgrade, 11000, Serbia

    Sanja Milutinovic, Goran Radunovic, Maja Zlatanovic & Nemanja Damjanov

  2. Department of Probability and Statistics, Faculty of Mathematics, University of Belgrade, Belgrade, Serbia

    Kristina Veljkovic

Authors
  1. Sanja Milutinovic
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  2. Goran Radunovic
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  3. Kristina Veljkovic
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  4. Maja Zlatanovic
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  5. Nemanja Damjanov
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Contributions

SM designed, coordinated, and continuously reviewed the study, performed the US assessments, participated in data management and statistical analyses, and prepared the manuscript for publication. GR participated in the conception and design of the study and drafting the manuscript, performed the US assessments, and participated in data management. KV performed the statistical analyses, participated in drafting the manuscript, and prepared the manuscript for publication. MZ performed clinical assessments and participated in drafting the manuscript. ND participated in all analysis and interpretation of data, as well as in drafting the manuscript. All authors read and approved the final version of the manuscript. The authors have declared that there is no external language editing support.

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Correspondence to Sanja Milutinovic.

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Conflict of interest

Sanja Milutinovic, Goran Radunovic, Kristina Veljkovic, Maja Zlatanovic, and Nemanja Damjanov declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Milutinovic, S., Radunovic, G., Veljkovic, K. et al. Construct validity and sensitivity to change of Belgrade Ultrasound Enthesitis Score in patients with spondyloarthritis: a pilot study. Rheumatol Int 38, 383–391 (2018). https://doi.org/10.1007/s00296-017-3898-8

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  • DOI: https://doi.org/10.1007/s00296-017-3898-8

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