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

Terslev, Lene; Naredo, Esperanza; Iagnocco, Annamaria; Bálint, Péter; Wakefield, Richard J.; Aegerter, Philippe; Aydın, Sibel Zehra; Bachta, Artur; Hammer, Hilde Berner; Bruyn, G. A. W.; Filippucci, Emilio; Gandjbakhch, Frédérique; Mandl, Péter; Pineda, Carlos; Schmidt, Wolfgang A.; D'Agostino, Maria Antonietta

doi:10.1002/acr.22191

Cited by 186 publications

(155 citation statements)

References 22 publications

Supporting

Mentioning

148

Contrasting

Unclassified

Order By: Relevance

“…Generally, the reading reliability was good but with less satisfactory results for acquisition reliability [3,4,23,25,32,34,38,41,44,47,48,51,54,55,61,65,73].…”

Section: Omeract Filter Us Discrimination Capacitymentioning

confidence: 99%

“…Erosions, enthesophytes, calcification, and cortical irregularities were included as signs of structural damage and therefore suggesting the presence of chronic/inactive US enthesitis. Due to poor agreement, differentiation between acute and chronic enthesitis could not be made [41].…”

Section: Imaging Evaluationmentioning

confidence: 99%

“…Therefore, a higher homogeneity in future studies is needed [41]. The US task force group focused on 4 areas of interest as follows: defining a normal US enthesis and other normal anatomis structures, identifying the elementary lesions in B mode and Doppler US to be included in the enthesitis definition after achieving a high expert agreement, defining the elementary lesions, and delineating lesions reflecting inflammation and structural damage.…”

Section: Imaging Evaluationmentioning

confidence: 99%

See 2 more Smart Citations

Concepts in monitoring enthesitis in patients with spondylarthritis- the role of musculoskeletal ultrasound

Micu

Fodor

2016

Med Ultrason

View full text Add to dashboard Cite

Enthesitis is the key pathological lesion in the spondyloarthritides group and an important element for early diagnosis with a predictive and prognostic value. The recognition of enthesitis on a clinical basis alone remains a challenge and creates unnecessary delays in diagnosis and adequate treatment commencement. Musculoskeletal ultrasound is a valid, reliable, and feasible imaging tool valuable for identifying inflammatory and structural lesions at enthesis level, helpful in establishing a diagnosis, evaluating disease activity and therapy monitoring. This paper focuses on the most relevant aspects of current literature regarding enthesitis and highlights the musculoskeletal ultrasound added value in enthesis assessment.

show abstract

“…Generally, the reading reliability was good but with less satisfactory results for acquisition reliability [3,4,23,25,32,34,38,41,44,47,48,51,54,55,61,65,73].…”

Section: Omeract Filter Us Discrimination Capacitymentioning

confidence: 99%

Section: Imaging Evaluationmentioning

confidence: 99%

Section: Imaging Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Concepts in monitoring enthesitis in patients with spondylarthritis- the role of musculoskeletal ultrasound

Micu

Fodor

2016

Med Ultrason

View full text Add to dashboard Cite

show abstract

“…In the absence of a gold standard for diagnosis, it is unclear whether imaging is a better tool than clinical assessment 27,29,30,31,32,33,34,35 . Outside the clinical trial setting, a combination of clinical suspicion and physical examination plus an objective assessment of inflammation (by ultrasound or MRI) would aid in the proper diagnosis of enthesitis, as well as choice of therapy.…”

Section: Rheumatologymentioning

confidence: 99%

Performance of 3 Enthesitis Indices in Patients with Peripheral Spondyloarthritis During Treatment with Adalimumab

Mease¹,

Bosch²,

Sieper³

et al. 2017

J Rheumatol

View full text Add to dashboard Cite

Objective.To evaluate the validity of enthesitis indices in patients with peripheral spondyloarthritis (pSpA).Methods.The ABILITY-2 study evaluated the efficacy of adalimumab (ADA) versus placebo (PBO) in patients with active pSpA over 12 weeks. Patients received open-label ADA for an additional 144 weeks. Twenty-nine enthesitis sites used in 3 enthesitis scoring systems [Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)] were assessed; discriminatory capacity and treatment response at Week 12 were calculated by standardized mean difference (SMD) and Guyatt’s effect size (ES). Sites showing resolution or new-onset enthesitis from baseline to Week 12 were analyzed.Results.Overall, 165 patients (ADA, n = 84; PBO, n = 81) were randomized; 143 had ≥ 1 enthesitis site at baseline. The LEI (SMD −0.73, ES −1.07) and SPARCC (SMD −0.56, ES −0.99) enthesitis indices showed higher discriminatory ability and treatment response than MASES (SMD −0.32, ES −0.81). At Week 12, among sites that were positive at baseline, significantly more (p < 0.05) showed resolution among patients treated with ADA versus PBO in the Achilles tendon (60.4% and 36.5%, respectively), medial epicondyle (73.2%, 48.7%), lateral epicondyle (80.6%, 52.8%), and iliac crest (73.5%, 47.2%). Among negative sites at baseline, significantly less (p < 0.05) new-onset enthesitis was observed with ADA versus PBO for Achilles tendon (3.6% and 10.9%, respectively), greater trochanter (3.4%, 14.4%), lateral epicondyle humerus (4.7%, 15.1%), medial femoral condyle (1.6%, 9.2%), and quadriceps insertion superior patella (1.5%, 7.0%).Conclusion.The LEI and SPARCC enthesitis indices showed better discriminatory capacity and treatment response in patients with pSpA versus MASES, likely because these indices contain more peripheral sites. Trial registration number: ClinicalTrials.govNCT01064856.

show abstract

“…Several clinical and US outcome measures for enthesitis in patients with PsA exists; however, their clinical use may be limited by time restraints and lack of training and consensus in the use of these tools 18,21 . The present study showed a significant increase in ICC after training for both LEI and SPARCC scores.…”

Section: Discussionmentioning

confidence: 99%

Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound

Kristensen

Christensen

Schmidt

et al. 2016

MLTJ

View full text Add to dashboard Cite

SummaryBackground: Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability. Objective: To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clinical examination for the detection of entheseal abnormalities. Methods: 20 rheumatologists performed repeated assessment of enthesitis in patients with established psoriatic arthritis before and after a 2-hour training session in standardised enthesitis count according to Leeds 5 . LEI has been developed for measuring enthesitis in patients with PsA 6 . However, all the scoring systems are known to have limitations in terms of reliability, validity, and sensitivity 3 . Another limitation of clinical enthesitis count is the specificity of the finding of tenderness in these areas. Many of the entheseal points are relatively near to joints and accepted tender points for fibromyalgia, raising the possibility of misclassification. Imaging modalities such as ultrasound (US) have been investigated to determine whether they improve entheseal disease assessment. Studies have shown that US indices for enthesitis are more sensitive than clinical examination 7,8 . The OMERACT US Specialist Interest Group has achieved agreement on US definition of enthesitis and its elementary components to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work 9 . However, the value of US findings at the enthesis is not investigated fully. Although Doppler sign at the enthesis is found more frequently in patients with PsA, as compared to healthy controls 10 , it can also be seen in patients with rheumatoid arthritis 11 . Bone changes such as enthesophytes and erosions may also be found as degenerative changes in weight-bearing entheses 12 . Furthermore, the application of US in daily practice in patients with PsA is limited by the time required to examine multiple sites of enthesitis. Since clinical enthesitis is a hallmark feature of PsA, there is a need for improvement of clinical assessment of enthesitis and evaluation of the benefits of US as an outcome measure in daily practice. The aim of this study was to examine if training in standardised assessment of enthesitis according to LEI and SPARCC is able to improve interobserver variation in patients with established PsA. Furthermore, we aimed to compare US and clinical assessment of enthesitis to determine the added value of US in enthesitis assessment. Methods SubjectsOutpatients with PsA according to Classification Criteria for Psoriatic Arthritis (CASPAR criteria) were enrolled from the Departments of Rheumatology, Aalborg University Hospital, Denmark, during routine presentation to the clinic. The inclusion criteria were established PsA requiring systemic treatment with disease modifying anti-rheumatic drugs. Exclusion criteria were treatment with biological drugs or treatment with oral corticosteroids. All patients taking NSAID...

show abstract

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

Cited by 186 publications

References 22 publications

Concepts in monitoring enthesitis in patients with spondylarthritis- the role of musculoskeletal ultrasound

Concepts in monitoring enthesitis in patients with spondylarthritis- the role of musculoskeletal ultrasound

Performance of 3 Enthesitis Indices in Patients with Peripheral Spondyloarthritis During Treatment with Adalimumab

Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound

Contact Info

Product

Resources

About