Correlation Between Clinical and Ultrasonographic Examination of the Calcaneal Enthesis in Patients with Ankylosing Spondylitis: A Controlled Study

Suellen Narimatsu¹, Rita N.V. Furtado¹, Andre Rosenfeld², Germana. B. Q. Estrela¹, Jorge E. P. Proglhof² and Jamil Natour³, ¹Rheumatology, Universidade Federal de São Paulo, São Paulo, Brazil, ²Radiology, Universidade Federal de São Paulo, São Paulo, Brazil, ³Rheumatology Division, Universidade Federal de São Paulo, São Paulo, Brazil

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: ankylosing spondylitis (AS) and ultrasound, Clinical, Enthesitis

Session Information

Title: Imaging of Rheumatic Diseases: Ultrasound, Nuclear Medicine and Fluorescence Imaging

Session Type: Abstract Submissions (ACR)

Background/Purpose:

1 – To compare US findings of calcaneal entheses between AS patients and healthy subjects;

2 – To assess the calcaneal entheses by US and correlate with clinical, functional and inflammatory aspects in patients with AS.

Methods:

We conducted a cross sectional study of 50 patients with AS and 30 healthy volunteer subjects matched for age and sex. The clinical evaluation of patients included a global health scale, visual analogue scale (VAS) for pain and edema, calculation of BASDAI, BASFI, BASMI, HAQ-S, ASDAS-VHS and enthesitis index SPARCC (Spondyloarthritis Research Consortium of Canada Enthesitis Index). The US exam was performed at right and left entheses of samples by a radiologist expert in musculoskeletal “blind” to clinical findings. The analysis of the US was based on MASEI index (Madrid Sonographic Enthesis Index) and the total analysis of its subitems. For evaluation was used the Esaote MyLab60 machine equipped with a linear transducer with a frequency of 6-18 MHz.

Results:

Were evaluated by the US 160 calcaneal entheses in the whole sample. The patients had ages between 18-65 years (43.44 + 9.91) and healthy subjects 18-65 years (38.7 +8.52). The mean disease duration was 11.11 (+ 6.77) years. The comparison of average Masei between patient and control groups (16.32 + 11.11 / 10.70 + 5.27) was not significantly different (p = 0.519). The comparison of each find in the US between groups showed statistical significance for the detection of erosion (17 patients / healthy 0) with p = 0.00 and power Doppler (PD) (6/0) with p = 0.053. There was no correlation between the presence of bursitis, calcification, erosion, thickening, structural change in the US evaluation of calcaneal tendon with clinical, functional, inflammatory activity in patients. However, the PD of the entheses was correlated with VAS pain (0.344, p= 0.00) and VAS edema (0.486, p = 0.00). The VAS pain and VAS for edema of the calcaneal entheses correlated statistically (0.653, p = 0.00).

Conclusion:

The US of the calcaneal entheses of individuals with AS had more erosion and capture the PD when compared with control subjects. The PD on these entheses was the only parameter on US that correlates with clinical variables.

Disclosure:

S. Narimatsu,
None;

R. N. V. Furtado,
None;

A. Rosenfeld,
None;

G. B. Q. Estrela,
None;

J. E. P. Proglhof,
None;

J. Natour,
None.

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