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

Freeston, Jane; Coates, Laura C.; Helliwell, Philip S.; Hensor, Elizabeth M A; Wakefield, Richard J.; Emery, Paul; Conaghan, Philip G.

doi:10.1002/acr.21733

Cited by 77 publications

(81 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Also, In contrast to our results, Narváez J [29] found that the distinctive findings of enthesitis were present in nearly 71 % of PsA patients in MRI results. However, Freeston J [30] found that 57.1 % of the PsA group had clinical evidence of at least one tender enthesis.…”

Section: Discussionmentioning

confidence: 99%

Enthesopathy and the Cutaneous Disease Activities in Psoriatic Arthritis

et al. 2013

View full text Add to dashboard Cite

Aim: To investigate entheseal abnormalities by using Leeds Enthesitis Index (LEI) score in Psoriatic arthritis (PsA). Also, to find the correlation of LEI score and parameters of the activities of the cutaneous disease at baseline and after 6 months of treatment in PsA. Furthermore, to find correlation between LEI score and C-reactive protein (CRP) and Psoriasis Area and Severity Index (PASI) score as well as acute phase reactants. Materials and Methods:A total of thirty-nine patients with PsA and thirty-five age and sex matched healthy subjects were recruited. Clinical and laboratory assessment of disease activity included LEI score, PASI score, erythrocyte sedimentation rate (ESR) and CRP and were measured at baseline and after 6 months of treatment.Results: Enthesopathy showed a significant prevalence among PsA of 20.5%. We found a highly significant decreased in LEI score, PASI score, ESR and CRP at baseline compared to results after 6 months of treatment in PsA. A significant correlation between PASI score and LEI score was found. Also, PASI score was significant correlated with ESR and CRP in PsA. Conclusion:Enthesopathy showed a significant prevalence among PsA. The good potential parameters for PsA were LEI score, PASI score, ESR and CRP in PsA. Also, they may be the predictive value of changes induced by biological treatment in PsA.

show abstract

Section: Discussionmentioning

confidence: 99%

Enthesopathy and the Cutaneous Disease Activities in Psoriatic Arthritis

et al. 2013

View full text Add to dashboard Cite

show abstract

“…ультрасо-нографию использовали для оценки энтезита при СА, и, возможно, именно она является предпочитаемым ме-тодом визуальной диагностики также для осмотра компо-нентов мягких тканей энтезиса и поверхности кости [35,[37][38][39], в ходе чего могут быть выявлены оба энтезиаль-ных случая: образование новой кости и эрозия. Тем не менее с помощью ультрасонографии нельзя наверняка отличить воспаление от механически индуцированной энтезопатии нижних конечностей у пациентов с субкли-ническим ПА [40]. В дополнение к этому Мандль и др.…”

Section: выявление энтезита при саunclassified

“…[50] затруднились оценить реакцию связок коленного сустава на терапию при остеоартрозе, ревматоидном артрите и псориатическом артрите путем применения вышеуказанных методов из-за различий в их стандартизации и реализации обследования. Хотя методы визуальной диагностики, как правило, при обна-ружении энтезита более чувствительны, чем клиническое обследование, последнее в некоторых случаях может переоценить наличие энтезита [40,51].…”

Section: выявление энтезита при саunclassified

Enthesitis and Psoriatic Onychopathy as a Factor for Prediction of Psoriatic Arthritis in Psoriasis

Сидорчик

Линев

Радзыня

et al. 2018

Vestnik dermatologii i venerologii

View full text Add to dashboard Cite

Psoriatic arthritis is a psoriasis-related spondyloarthropathy that occurs in 20–30 % of patients with psoriasis. Psoriatic arthritis affects the patient’s quality of life indicators and are more often associated with disabilities of working age than psoriasis skin form. Nail psoriasis has been proposed as a predictor for the development of psoriatic arthritis. The inflammation involving the entheses, called enthesitis, is an early inflammatory change seen in psoriatic arthritis, and nail changes appear to result from the close relationship between the nail and the enthesis of the distal interphalangeal extensor tendon, one of the main entheseal compartments affected in psoriatic arthritis. Various imaging studies have demonstrated that there is a considerable proportion of undiagnosed psoriatic arthritis among patients with psoriasis. Since early detection and treatment of psoriatic arthritis could, ultimately, allow the prevention of clinical and radiologic progression of the disease, there is the need to establish clinical indicators to detect this risk.

show abstract

“…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.…”

Section: Assessment Of Enthesitis In Patients With Psoriatic Arthritimentioning

confidence: 99%

“…The poor association between PD and enthesitis scores in our study might be explained by the fact that there are fewer vessels in inflamed enthesis compared with synovium making it harder to visualize 22,23 . US examinations was assessed in positions previously described 12 but not fully relaxed positions, and this may also contribute to reduction of the sensitivity of PD [24][25][26][27] . Previous studies by Gutierrez et al 28 , Koenig et al 29 and Zappia et al 30 revealed changes in intratendinous PD related to joint position.…”

Section: Before Instruction After Instructionmentioning

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

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

Cited by 77 publications

References 13 publications

Enthesopathy and the Cutaneous Disease Activities in Psoriatic Arthritis

Enthesopathy and the Cutaneous Disease Activities in Psoriatic Arthritis

Enthesitis and Psoriatic Onychopathy as a Factor for Prediction of Psoriatic Arthritis in Psoriasis

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

Contact Info

Product

Resources

About