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Performance of ultrasound to monitor Achilles enthesitis in patients with ankylosing spondylitis during TNF-a antagonist therapy

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Abstract

Enthesitis is considered as the primary anatomical lesion in ankylosing spondylitis (AS). We aimed to investigate the potential of ultrasound to detect early changes after TNF-a antagonist therapy of Achilles enthesitis of AS patients. One hundred AS patients with active disease, requiring TNF-a antagonist therapy, were included (etanercept n = 25, infliximab n = 25, adalimumab n = 25, non-biologic disease-modifying antirheumatic drugs (DMARDs) n = 25). Physical examination was performed to evaluate disease activity and detect Achilles enthesitis and/or retrocalcaneal bursitis. Ultrasound of the Achilles enthesitis was performed bilaterally. Follow-up examinations were performed 3 months after the initiation of therapy. Gray scale (GS) scores, Power Doppler (PD) scores, and total additive scores (TS) decreased significantly during TNF-a antagonist therapy but not in traditional non-biologic traditional DMARDs group. The bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis metrology index (BASMI), bath ankylosing spondylitis functional index (BASFI), and Maastricht ankylosing spondylitis enthesitis score (MASES) all showed significant improvements. When three different TNF-a antagonists were analyzed separately, no significant difference was observed in GS, PD, and total scores. Subclinical Achilles enthesitis, detected only with GS ultrasound, is present in a subset of AS patients and a significant improvement can be demonstrated after 3 months of TNF-a antagonist therapy. Doppler ultrasound provides a reliable estimation to monitor the therapeutic response to TNF antagonists in AS patients with Achilles enthesitis. TNF-a antagonists have been shown to be effective in decreasing ultrasound signs of enthesitis after 3 months of therapy in AS patients.

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Acknowledgments

The authors would like to thank experienced technician Yan-hong Wang and Chun-mei Fan for their excellent technical assistance.

Disclosure

None.

Funding

This work was supported by grants from the National Natural Science Foundation of China (No.81202299), Xijing Hospital Foundation (No.XJGX13LC21), and Pfizer 2010 China RA Grant (No.WS1595293).

Ethics approval

The approval was granted from the Ethics Committee of Fourth Military Medical University. All patients and controls gave their informed consent to participate in the study.

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    Authors and Affiliations

    1. Department of Clinical Immunology, Xijing Hospital, First Affiliated Hospital of Fourth Military Medical University, Xi’an, People’s Republic of China

      Cong-hua Wang, Yuan Feng, Zhen Ren, Xichao Yang, Jun-feng Jia, Meng-yao Rong, Xue-yi Li & Zhen-biao Wu

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    1. Cong-hua Wang
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    2. Yuan Feng
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    Correspondence to Cong-hua Wang, Xue-yi Li or Zhen-biao Wu.

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    Cong-hua Wang, Yuan Feng, Zhen Ren and Xichao Yang contributed equally to this work.

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    Wang, Ch., Feng, Y., Ren, Z. et al. Performance of ultrasound to monitor Achilles enthesitis in patients with ankylosing spondylitis during TNF-a antagonist therapy. Clin Rheumatol 34, 1073–1078 (2015). https://doi.org/10.1007/s10067-015-2939-5

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    • DOI: https://doi.org/10.1007/s10067-015-2939-5

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