Session Title: Imaging of Rheumatic Diseases: Ultrasound
Session Type: Abstract Submissions (ACR)
Spondyloarthritis (SpA) are characterized by inflammatory and structural changes in the entheses (enthesitis). However, enthesitis is not only observed in SpA and can also be seen after a hypersollicitation of the enthese as during intensive sport.
The purpose of the study was to compare ultrasound (US) findings of entheses between 3 groups: axial SpA patients, athletes and healthy controls.
We conducted a prospective cross-sectional study of 30 axial SpA (2009ASAS criteria), 30 athletes and 30 controls. Athlete subjects practiced a sport resulting in a strain on lower limbs, such as running or soccer, at least 6 hours per week. Controls practiced less than an hour per week. Clinical evaluation and US were performed at the same day. Physicians performing clinical and US examination were blinded to each other. The US was performed at by two radiologists, using both grey scale (GS) and power Doppler (PD) for calculation of the MASEI index (Madrid Sonographic Enthesis Index) and the analysis of its subitems (bursistis, calcification, erosion, power doppler, thicknening of tendon, structural change) (Toshiba Aplio 500, linear transducer, frequency of 6–18 MHz). Analysis: To compare groups we used chi-square and one-way analysis of variance (ANOVA) with Bonferroni correction for post-hoc tests (depending on categorical/continuous variables), and Mann Whitney test for correlation (SPSS 17.0 version).
Patients and controls demographic and clinical characteristics are shown in table 1. In SpA patients mean (SD) BASDAI and ASDAS were 3,14 (1,9) and 1,78 (1,01), respectively. Mean MASEI and each sub-item scores were significantly different between SpA patients and both healthy control groups. There was no difference between athlete and non-athlete groups. No correlation between heel pain and MASEI score or PD of the calcaneal enthese was found. The inter-reader correlation for MASEI scoring was 0.68 (Cohen’s kappa coefficient).
The MASEI score was significantly higher in patients with SpA compared to healthy control, athletes and non-athletes. Even if the MASEI score was somewhat higher in the athlete group than in the non-athlete control group, the difference was not significant. The 17-cutoff seems relevant to distinguish SpA from control, whatever their physical activity.
M. A. Lanfranchi,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-entheses-ultrasound-findings-similar-in-axial-spa-patients-and-in-athletes/