Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: A cross‐sectional study

D'Agostino, Maria Antonietta; Said‐Nahal, Roula; Hacquard-Bouder, Cécile; Brasseur, J.-L.; Dougados, Maxime; Bréban, Maxime

doi:10.1002/art.10812

Cited by 497 publications

(376 citation statements)

References 33 publications

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“…These data have shown that the prevalence of subclinical active enthesitis in early PsA is low compared with previous studies of established disease (2,7). The small number of subclinically inflamed entheses were found in the lower extremity, where mechanical stress through weight-bearing entheses is likely to be more significant.…”

Section: Discussioncontrasting

confidence: 43%

“…Of note, PD was not used, therefore specificity for active inflammation was likely to have been reduced. D'Agostino et al showed abnormal ultrasound findings in 38% of entheses examined in an SpA cohort and in 11% of entheses in a control cohort, the latter composed of RA and mechanical low back pain patients (2). None of the abnormal entheses in the control subjects showed evidence of vascularization compared to 81% entheses in the SpA group.…”

Section: Discussionmentioning

confidence: 97%

“…Inflammation at the site of tendon, aponeurosis, or ligament insertion into bone, known as enthesitis, is a recognized pathologic finding in the spondylarthritis (SpA) group of diseases, including psoriatic arthritis (PsA) (1)(2)(3). Enthesitis may be the primary pathologic abnormality in PsA (1), where synovitis is secondary to liberation of proinflammatory cytokines from the enthesis, in contrast to the primary synovitis seen in rheumatoid arthritis (RA).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound

Freeston¹,

Coates²,

Helliwell³

et al. 2012

Arthritis Care & Research

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Objective. Enthesitis is a recognized feature of spondylarthritides (SpA), including psoriatic arthritis (PsA). Previously, ultrasound imaging has highlighted the presence of subclinical enthesitis in established SpA, but there are little data on ultrasound findings in early PsA. The aim of our study was to compare ultrasound and clinical examination (CE) for the detection of entheseal abnormalities in an early PsA cohort. Methods. Forty-two patients with new-onset PsA and 10 control subjects underwent CE of entheses for tenderness and swelling, as well as gray-scale (GS) and power Doppler (PD) ultrasound of a standard set of entheses. Bilateral elbow lateral epicondyles, Achilles tendons, and plantar fascia were assessed by both CE and ultrasound, the latter scored using a semiquantitative (SQ) scale. Inferior patellar tendons were assessed by ultrasound alone. A GS SQ score of >1 and/or a PD score of >0 was used to describe significant ultrasound entheseal abnormality. Results. A total of 24 (57.1%) of 42 patients in the PsA group and 0 (0%) of 10 controls had clinical evidence of at least 1 tender enthesis. In the PsA group, for sites assessed by both CE and ultrasound, 4% (7 of 177) of nontender entheses had a GS score >1 and/or a PD score >0 compared to 24% (9 of 37) of tender entheses. CE overestimated activity in 28 (13%) of 214 of entheses. All the nontender ultrasound-abnormal entheses were in the lower extremity. Conclusion. The prevalence of subclinical enthesitis in this early PsA cohort was low. CE may overestimate active enthesitis. The few subclinically inflamed entheses were in the lower extremity, where mechanical stress is likely to be more significant.

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Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound

Freeston¹,

Coates²,

Helliwell³

et al. 2012

Arthritis Care & Research

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“…A close relationship between the different SpA subtypes is supported by several observations, including anatomic studies of the skeletal lesions that have isolated enthesitis as a characteristic feature of SpA (1)(2)(3) and the role of HLA-B27, a genetic predisposing factor shared by the different varieties of SpA (4). There is, however, some difficulty in establishing a formal distinction between subtypes as defined above because of frequent overlapping presentations in individual patients.…”

Section: Introductionmentioning

confidence: 88%

Two major spondylarthropathy phenotypes are distinguished by pattern analysis in multiplex families

Porcher

Said‐Nahal

D'Agostino

et al. 2005

Arthritis & Rheumatism

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Objective. To examine whether spondylarthropathy (SpA) disease manifestations would combine in any ordered pattern among patients from SpA multiplex families. Methods. SpA patients (n ‫؍‬ 540) belonging to 190 multiplex families were thoroughly investigated. Clinical data was collected, systematic pelvic radiographs were taken, and HLA-B27 status was determined. The patterns of SpA manifestations were examined by several methods, including multiple correspondence analysis, nonhierarchical and hierarchical clustering, and discriminant analysis. Results. The nonhierarchical cluster analysis allowed us to classify patients, independent of disease duration, into 2 major groups of comparable size. Group A contained a majority of the women, whereas group B predominantly consisted of men. The 2 groups were very similar regarding axial symptoms, radiographic sacroiliitis, and uveitis. Group B was characterized by a younger age at onset and a higher frequency of clinical enthesitis, peripheral arthritis, dactylitis, psoriasis, and inflammatory bowel disease than group A. Patients belonging to those groups exhibited some degree of familial aggregation, thereby supporting their intrinsic validity. Conclusion. Pattern analysis of SpA manifestations among familial SpA allowed us to recognize 2 main clusters independent of disease duration. Furthermore, there was a trend toward aggregation by cluster among families, suggesting that they are determined by specific genetic factors. These clusters may indeed correspond to different severity patterns.

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“…Both SF and SH are evaluated primarily on gray-scale (GS) ultrasound, while Color Doppler (CD) and Power Doppler (PD) are utilized to demonstrate activity related to SH. By visualizing the intravascular movement of blood cells, CD and PD detect microvascular blood flow in synovial and entheseal inflammation 5,6 . At the single-joint level, synovitis and effusion in GS were initially evaluated by binary grading (presence/absence) 7 .…”

mentioning

confidence: 99%

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

Mandl

Naredo²,

Wakefield³

et al. 2011

J Rheumatol

186

110

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Objective. The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed. Methods. A systematic literature search of Pubmecl and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis. Results. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Conclusions. Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed. (J Rheumatol 2011; 38:2055-62; doi:10.3899/jrheum.110424

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Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: A cross‐sectional study

Cited by 497 publications

References 33 publications

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound

Two major spondylarthropathy phenotypes are distinguished by pattern analysis in multiplex families

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

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