Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography

Kiris, Adem; Kaya, Arzu; Özgöçmen, Salih; Kocakoç, Ercan

doi:10.1007/s00256-005-0071-3

Cited by 102 publications

(74 citation statements)

References 20 publications

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“…In their definitions, both calcification and enthesophyte findings with and without acoustic shadowing were included, and it is worth noting that, although in most cases both pathologies give acoustic shadowing, this may not necessarily be the case for small abnormalities (19 -21). No agreement was obtained, however, for the inclusion of bursitis, tendinitis, or cortical irregularities as elementary lesions of enthesitis, although their inclusion has been suggested by others (3,(22)(23)(24). The obtained consensus is a major step toward ensuring homogeneity in future studies.…”

Section: Discussionmentioning

confidence: 87%

Defining Enthesitis in Spondyloarthritis by Ultrasound: Results of a Delphi Process and of a Reliability Reading Exercise

Terslev

Naredo

Iagnocco

et al. 2014

Arthritis Care & Research

186

145

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Objective. To standardize ultrasound (US) in enthesitis.Methods. An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability. Results. Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13-1. The interobserver kappa values were variable, with the lowest kappa coefficient for enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63). Conclusion. This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.

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Section: Discussionmentioning

confidence: 87%

Defining Enthesitis in Spondyloarthritis by Ultrasound: Results of a Delphi Process and of a Reliability Reading Exercise

Terslev

Naredo

Iagnocco

et al. 2014

Arthritis Care & Research

186

145

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“…Third, there are no standardized validated methods of assessing pediatric enthesitis (such as specifying a set load of pressure to be applied during examination), so our data rely upon the subjective physician assessment recorded in the EHR, which is the current gold standard of pediatric entheses examination. Studies in adults demonstrate a good, but not perfect, correlation between clinical and ultrasound enthesitis (22,23). Similar studies in children are greatly needed to determine if imaging needs to play a more prominent role in the diagnosis of enthesitis.…”

Section: Discussionmentioning

confidence: 99%

Enthesitis in an inception cohort of enthesitis‐related arthritis

Weiss¹,

Klink²,

Behrens³

et al. 2011

Arthritis Care & Research

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Objective. To describe an enthesitis-related arthritis (ERA) inception cohort and determine which entheses and joints are most commonly affected. Methods. We reviewed a retrospective inception cohort study of children with ERA who were diagnosed and treated at The Children's Hospital of Philadelphia between November 2007 and December 2009. Results. During the study period, there were 32 newly diagnosed ERA patients. Fifty-nine percent were male, and the median age at the date of initial evaluation was 12.5 years (interquartile range [IQR] 10.2-14.3 years). The median number of tender entheses at presentation was 2 (IQR 0 -5), and 21 subjects (66%) had at least 1 tender enthesis. The most prevalent tender entheses were the patellar ligament insertion at the inferior pole of the patella, the plantar fascial insertion at the calcaneus, the Achilles tendon insertion at the calcaneus, and the plantar fascial insertion at the metatarsal heads. Enthesitis was most often symmetric. The median number of active joints was 2 (IQR 0 -4). The most commonly affected joints were the sacroiliacs, knees, and ankles. Sacroiliitis, which was defined clinically, was most often symmetric, while peripheral arthritis was most frequently asymmetric. The odds of having active enthesitis at 6 months increased significantly with each additional tender enthesis at the initial evaluation. Conclusion. Among pediatric patients with ERA, lower extremity enthesitis is prevalent at the time of diagnosis and is likely to persist 6 months later. Future studies should address standardization of the enthesitis examination, the pattern of enthesitis over time, enthesitis response to therapy, and the impact of enthesitis on quality of life.

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“…These entheses are usually superficial structures and use of PDUS enables assessment of the involvement, extent of inflammation, and response to therapy. Our group reported previously that pain and tenderness at these enthesitis sites correlated with increased vascularization (22). We also underscored that PDUS examination of entheses may be useful and complementary to a clinical examination in patients with SpA.…”

Section: Ankylosing Spondylitismentioning

confidence: 55%

“…The most frequent sites of increased vascularization were the Achilles tendon insertion (Fig. 3), the first costochondral joint, and the anterior superior iliac spine (22).…”

Section: Ankylosing Spondylitismentioning

confidence: 99%

Doppler US in rheumatic diseases with special emphasis on rheumatoid arthritis and spondyloarthritis

Toprak

Kılıç

Serter³

et al. 2013

Diagn Interv Radiol

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Developments in digital ultrasonography (US) technology and the use of high-frequency broadband transducers have increased the quality of US imaging, particularly of superficial tissues. Thus, US, particularly color US or power Doppler US, in which high-resolution transducers are used, has become an important imaging modality in the assessment of rheumatic diseases. Furthermore, therapeutic interventions and biopsies can be performed under US guidance during the assessment of lesions. In this era of effective treatments, such as biologics, improvements in synovial inflammation in rheumatoid arthritis as well as changes in enthesitis in spondyloarthropathies, including ankylosing spondylitis and psoriatic arthritis, can be monitored effectively using gray-scale and/ or power Doppler US. US is also a good imaging modality for crystal arthropathies, including gout and pseudogout, in which synovitis, erosions, tophi, and crystal deposition within or around the joint can be visualized readily. Vascular and tenosynovial structures, as well as the salivary glands, can be assessed with US in vasculitis and connective tissue disorders, including systemic lupus erythematosus and Sjögren's syndrome. Current research is focused on improving the sensitivity, specificity, validity, and reproducibility of US findings. In this review, we summarized the role of US, particularly power Doppler US, in rheumatic diseases and inflammation in superficial tissues.

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Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography

Abstract: 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.

Cited by 102 publications

References 20 publications

Defining Enthesitis in Spondyloarthritis by Ultrasound: Results of a Delphi Process and of a Reliability Reading Exercise

Defining Enthesitis in Spondyloarthritis by Ultrasound: Results of a Delphi Process and of a Reliability Reading Exercise

Enthesitis in an inception cohort of enthesitis‐related arthritis

Doppler US in rheumatic diseases with special emphasis on rheumatoid arthritis and spondyloarthritis

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