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Abstract Number: 2638

Defining Sonographic Enthesitis in Psoriatic Arthritis: Developing a Data- and Expert-driven Diagnostic Criteria for Inflammatory Enthesitis at the Single Enthesis Level

Andre Lucas Ribeiro1, Sibel Aydin2, Gurjit Kaeley3, Fahmeen Afgani4, Catherine Bakewell5, Marcos Rosemffet6, Minna Kohler7, Amir Haddad8, Maria S. Stoenoiu9, Ari Polachek10, josefina marin11, Arnon Katz12 and Lihi Eder13, 1Women's College Hospital & University of Toronto, Porto Alegre, Rio Grande do Sul, Brazil, 2University of Ottawa - Ottawa, Ottawa, ON, Canada, 3UF COM-J, Ponte Vedra Beach, FL, 4Women's College Hospital, Toronto, Canada, 5Intermountain Healthcare, Salt Lake City, UT, 6Instituto de Rehabilitación Psicofísica, Capital Federal, Argentina, 7Massachusetts General Hospital, Boston, MA, 8Carmel Medical Centre, Haifa, Israel, 9Cliniques Universitaires Saint-Luc, Brussels, Belgium, 10Tel-Aviv Medical Center, Tel-Aviv, Israel, Petah-Tikva, Israel, 11Hospital Italiano de Buenos Aires, buenos aires, Argentina, 12GRAPPA - Patient Research Partner, Haifa, Israel, 13University of Toronto, Women’s College Hospital and Department of Medicine, Toronto, ON, Canada

Meeting: ACR Convergence 2024

Keywords: Diagnostic criteria, Imaging, Psoriatic arthritis, spondyloarthritis, Ultrasound

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Session Information

Date: Monday, November 18, 2024

Title: Abstracts: SpA Including PsA – Diagnosis, Manifestations, & Outcomes II

Session Type: Abstract Session

Session Time: 3:00PM-4:30PM

Background/Purpose: Clinical enthesitis occurs in 30-40% of psoriatic arthritis (PsA) patients, but its clinical diagnosis is challenging due to similarities to non-specific entheseal pain. Despite OMERACT’s standardization of ultrasound (US) entheseal lesions, a unified definition for inflammatory enthesitis remains vague. This study aims to develop data- and expert-driven diagnostic criteria to differentiate inflammatory enthesitis at the single enthesis level from non-specific sonographic enthesopathy.

Methods: An expert panel of 10 sonographers who participated in the Diagnostic Ultrasound Enthesitis Tool (DUET) study reviewed 90 US scans (stored as video clips) of PsA patients. These represented various severities of entheseal lesions from 6 different sites. Each investigator rated each scan on a scale from -10 (definite “No”) to +10 (definite “Yes”) for the likelihood of representing enthesitis. To be considered “Definite enthesitis” ≥ 70% of readers had to rate it with ≥ 70% certainty (+7 or higher). Sonographers also noted the sonographic features influencing their ratings. Consensus scoring (3 central readers) of elementary lesions was taken from the DUET study (Figure 1)1. Descriptive statistics and Chi-square tests were used to report differences in elementary lesions across categories.

Results: Preliminary results show that 29 (32.2%) scans were classified as “Definite enthesitis”, 21 (23.3%) as “Definite not enthesitis”, and 40 (44.5%) had no consensus (“Uncertain”).

“Definite enthesitis” scans had more elementary lesions compared to “Uncertain” and “Not enthesitis” scans (Figure 2A-B). 93.1% of “Definite enthesitis” scans had a combination of ≥ 4 elementary lesions, while “Uncertain” and “Not enthesitis” scans mostly had 3 or fewer lesions (52.5% and 100%, respectively).

The DUET scoring of elementary lesions and Chi-Square significant differences are shown in Figure 3A-F, highlighting the differences of Hypoechogenicity, Thickening, and Power Doppler (PD) between “Definite enthesitis” and “Uncertain” groups. Most “Definite enthesitis” scans had PD ≥ 2 (n=28, 96.5%), with the remaining scan showing significant B mode abnormalities, including erosions. The “Not enthesitis” group mostly had no elementary lesions (76.2%), with only 4 scans showing isolated enthesophytes and 1 with thickening. “Uncertain” scans showed a mixed combination of elementary lesions, with 55% having positive PD. Unlike the OMERACT definition of PD location in enthesitis, 68.1% of the PD was ≥ 2 mm from the insertion site, which was an important factor for classifying them as “Uncertain”.

Conclusion: The presence of inflammatory elementary lesions drives the opinion towards a categorization of definite enthesitis, particularly when high grade PD signal is present and when four or more elementary lesions are combined. Isolated enthesophytes, common in the general population, do not indicate inflammatory enthesitis. These initial insights will form the basis for an inflammatory enthesitis definition.

Reference

  1. Eder L, Aydin S, Kaeley G. The Reliability of Scoring Sonographic Entheseal Abnormalities – the Diagnostic Ultrasound Enthesitis Tool (DUET) Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10).

Supporting image 1

Supporting image 2

Supporting image 3


Disclosures: A. Lucas Ribeiro: None; S. Aydin: AbbVie/Abbott, 1, 2, 5, 6, Clarius, 11, Eli Lilly, 5, 6, Janssen, 1, 5, 6, Novartis, 1, 2, 5, 6, Pfizer, 1, 2, 5, 6, UCB, 1, 5, 6; G. Kaeley: AbbVie/Abbott, 5, Bristol-Myers Squibb(BMS), 5, Gilead, 5, Janssen, 5, Novartis, 5; F. Afgani: None; C. Bakewell: AbbVie/Abbott, 2, 6, Bristol-Myers Squibb(BMS), 2, Eli Lilly, 2, 6, Janssen, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, UCB, 2, 6; M. Rosemffet: None; M. Kohler: Janssen, 12, medical advisory board, Novartis, 12, medical advisory board, Setpoint Medical, 5, Springer Publications, 9; A. Haddad: None; M. Stoenoiu: AbbVie/Abbott, 5, 6, Janssen, 5, 6, Novartis, 5, 6, Pfizer, 5, 6, Roche, 5, 6, Sanofi, 5, 6, UCB, 5, 6; A. Polachek: None; j. marin: None; A. Katz: None; L. Eder: AbbVie, 2, 5, 6, Bristol-Myers Squibb (BMS), 2, Eli Lilly, 2, 5, Fresenius Kabi, 5, Johnson & Johnson, 2, 5, Novartis, 1, 5, Pfizer, 5, 6, UCB, 5, 6.

To cite this abstract in AMA style:

Lucas Ribeiro A, Aydin S, Kaeley G, Afgani F, Bakewell C, Rosemffet M, Kohler M, Haddad A, Stoenoiu M, Polachek A, marin j, Katz A, Eder L. Defining Sonographic Enthesitis in Psoriatic Arthritis: Developing a Data- and Expert-driven Diagnostic Criteria for Inflammatory Enthesitis at the Single Enthesis Level [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/defining-sonographic-enthesitis-in-psoriatic-arthritis-developing-a-data-and-expert-driven-diagnostic-criteria-for-inflammatory-enthesitis-at-the-single-enthesis-level/. Accessed .
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