Ultrasound differentiates SpA-related enthesitis from mechanical pathology
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Key takeaways:
- Ultrasound discriminated between SpA-related enthesitis and other pathologies.
- Power Doppler signal at enthesis and bone erosions was significantly associated with SpA.
Ultrasound can differentiate spondyloarthritis-related enthesitis from other entheseal pathologies such as mechanical enthesitis, according to data published in Annals of the Rheumatic Diseases.
Using ultrasound lesion definitions developed by the Outcome Measures in Rheumatology (OMERACT) task force, the researchers found that power Doppler signal at the enthesis, as well as bone erosions, best discriminated SpA. The Achilles tendon enthesis was found to be “the most informative entheseal site,” they wrote.
“Inflammatory involvement of the enthesis, or enthesitis, plays a key role in the pathogenesis, diagnosis and management of patients with spondyloarthritis,” Andrea Di Matteo, MD, of the rheumatology unit at Marche Polytechnic University, in Italy, and colleagues wrote. “Physical examination, which is routinely used in clinical practice for assessing enthesitis, is often inaccurate. Therefore, interest has grown towards the use of imaging, and in particular ultrasound, for the evaluation of enthesitis in SpA.”
To determine how well the definitions of ultrasound lesions of enthesitis discriminate between active enthesitis in patients with SpA vs. those with non-inflammatory rheumatic conditions, Di Matteo and colleagues conducted an observational, cross-sectional study across 20 rheumatology centers in 11 countries. The researchers recruited a total of 413 adult patients with SpA — including 224 with spondyloarthritis and 189 with psoriatic arthritis — and 282 control patients — 144 with osteoarthritis and 138 with fibromyalgia.
For each participant, five lower limb entheses underwent both physical examination and same-day ultrasound, performed by rheumatologists. To reveal the associations, Di Matteo and colleagues conducted a univariate analysis, as well as a multivariate analysis, adjusted for age and sex, encompassing all the ultrasound elementary lesions that were significantly associated with SpA in the univariate analysis.
The univariate analysis found that all the OMERACT lesions, except enthesophytes and calcifications, were significantly associated with SpA, according to the researchers. In the multivariable analysis, the lesions that remained significantly associated were power Doppler signal at enthesis (OR = 8.77; 95% CI, 4.4-19.2) and bone erosions (OR = 4.75; 95% CI, 2.43-10.1). The Achilles tendon was the only lower limb enthesis significantly associated with SpA (OR = 1.93; 95% CI, 1.3-2.88).
“Our study provided new insights into the discriminative value and clinical associations of the OMERACT ultrasound lesions of enthesitis in SpA,” Di Matteo and colleagues wrote. “Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving assessment of entheseal involvement in SpA.”
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