Doppler in Entheses: A Potential Useful Outcome in Active Spondyloarthritis and Psoriatic Arthritis

Juan Molina Collada¹, Cristina Macía-Villa ², Chamaida Plasencia ³, Diana Peiteado ⁴, Laura Nuño ⁵, Irene Monjo ⁶, Alejandro Villalba ⁷, Carolina Tornero ⁸, Patricia Bogas ¹, Luis Coronel ⁹, Gabriela González ¹, Diego Benavent ¹⁰, Elisa Fernández ¹¹, Pablo Rodríguez ¹, Gerardo Napky ¹, Alejandro Balsa ⁵ and Eugenio de Miguel ¹², ¹La Paz University Hospital, Madrid, Spain, ²Severo Ochoa University Hospital, Madrid, Spain, ³Immuno-Rheumatology Research Group, IdiPaz & Rheumatology Department. La Paz University Hospital, Madrid, Spain, ⁴Hospital Universitario La Paz, Madrid, ⁵Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain, Madrid, Spain, ⁶FIBHULP-IdiPAZ-Hospital La Paz-Rheumatology, Madrid, Spain, ⁷FIBHULP-IdiPAZ-Hospital La Paz-Rheumatology, Madrid, ⁸Rheumatology Department. La Paz University Hospital., Madrid, ⁹Nuestra Señora de la Candelaria University Hospital, Tenerife, Spain, ¹⁰Hospital Universitario La Paz, Madrid, Spain, ¹¹Rheumatology Department, La Paz University Hospital, Madrid, Madrid, Spain, ¹²Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ultrasound and enthesis

Session Information

Date: Sunday, November 10, 2019

Title: Imaging Of Rheumatic Diseases Poster I

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: The assessment of activity in spondyloarthritis (SpA) and psoriatic arthritis (PsA) involves several domains, including enthesitis. Clinical enthesitis has shown low sensitivity, specificity and reliability. The inclusion of ultrasound (US) can be an objective outcome in the assessment of the disease. Our objective is to assess the prevalence of peripheral US enthesitis using an US score, at patient level, among active SpA and PsA patients

Methods: A cross-sectional study in patients with SpA and PsA active disease (defined as patients who were going to start or switch biological therapy according to physician criteria and in agreement with clinical guidelines) was undertaken. Basal assessment included clinical features, physical examination and laboratory tests. Patients underwent bilateral US examination of peripheral entheses according to the MAdrid Sonographic Enthesitis Index (MASEI). MASEI and OMERACT enthesitis Power Doppler (PD) definitions were checked. Each enthesis was scanned in both the longitudinal and transverse planes, and 5 second videos were recorded for reliability. An inter-reader analysis by three readers was performed. For statistical analysis Mann-Whitney U test, Kruskal-Wallis test and intraclass correlation coefficients (ICCs) were used

Results: 36 patients were included, of whom 19(52.8%) were ankylosing spondylitis (AS) patients, 10(27.8%) PsA, and 7(19.4%) non radiographic axial spondyloarthritis (nr-axSpA). Mean age was 49.8±13.1 years and 18(50%) were females. Mean DAS28 (3.5±1.3), ASDAS (3.7±0.9), BASDAI (5.7±2.2) and CRP values (11.5±12.6) reflect moderate-high disease activity. Demographic and clinical baseline characteristics are shown in Table 1. Mean global MASEI score was 28.1(±9.1) and 30 patients (83.3%) scored ≥18 (proposed cut-off point to diagnose SpA). Abnormal US findings consistent with at least one enthesis showing PD signal (whether using MASEI or OMERACT PD definition) were observed in 29(80.6%) of patients while two or more PD in entheses were observed in 21(58.3%) patients (PD MASEI definition) or 18(50%) patients (PD OMERACT definition), without significant variation among the different SpA subtypes. The sites most commonly affected were the distal patellar, quadriceps and distal Achiles tendon (52.8%, 41.7% and 16.7%, respectively). The inter-reader reliability among the three readers was high (mean ICC of 0.85). Table 2 shows the ICC of every reader pair

Conclusion: Presence of PD enthesitis is found in 80% of patients with active SpA and PsA. This finding is independent of SpA subtype and support the usefulness of PD US in the assessment of enthesitis

Table 1

Table 1. Baseline characteristics of active SpA patients

Table 2

Table 2. Inter-reader reliability

Disclosure: J. Molina Collada, None; C. Macía-Villa, None; C. Plasencia, None; D. Peiteado, None; L. Nuño, BMS, 2; I. Monjo, BMS, 2; A. Villalba, BMS, 2; C. Tornero, None; P. Bogas, None; L. Coronel, None; G. González, None; D. Benavent, None; E. Fernández, None; P. Rodríguez, None; G. Napky, None; A. Balsa, None; E. de Miguel, AbbVie, 2, 5, 8, BMS, 8, BMS, MSD, UCB, Roche, 8, MSD, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 8, UCB, 8.

To cite this abstract in AMA style:

Molina Collada J, Macía-Villa C, Plasencia C, Peiteado D, Nuño L, Monjo I, Villalba A, Tornero C, Bogas P, Coronel L, González G, Benavent D, Fernández E, Rodríguez P, Napky G, Balsa A, de Miguel E. Doppler in Entheses: A Potential Useful Outcome in Active Spondyloarthritis and Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/doppler-in-entheses-a-potential-useful-outcome-in-active-spondyloarthritis-and-psoriatic-arthritis/. Accessed .

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