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Abstract Number: 1209

Peritenon Extensor Tendon Inflammation, Synovitis and Enthesopathy in Psoriastic Arthritis: What Is the Connection?

Cristina Macia-Villa1, Sandra Falcao2, Hilde B. Hammer3, Julio Medina4, Marwin Gutierrez5 and Eugenio De Miguel6, 1Hospital Universitario Severo Ochoa, Madrid, Spain, 2Department of Rheumatology. Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL; HEM. Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal, 3Dept. of Rheumtology, Diakonhjemmet Hospital, Oslo, Norway, 4Hospital Universitario Clínico, Valladolid, Spain, 5Rheumatology, Instituto Nacional de Rehabilitación, Mexico City, Mexico, 6Rheumatology, University Hospital La Paz, IdiPaz, Madrid, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Psoriatic arthritis and ultrasound

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Session Information

Date: Monday, October 22, 2018

Title: Imaging of Rheumatic Diseases Poster II: Ultrasound

Session Type: ACR Poster Session B

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

Background/Purpose:

Metacarpophalangeal joint (MCPj) swelling in Psoriatic Arthritis (PsA) can be produced both by synovitis (IAS) and peritenon extensor tendon inflammation (PTI), having been  this last lesion reported by some authors as an enthesitis-like lesion. Our objective was to explore the association of PTI and IAS with enthesitis in PsA, using the enthesis US score MASEI (Madrid Sonographic Enthesis Index).

Methods:

27 consecutive non selected PsA patients were included. An expert rheumatologist obtained US images from the dorsal aspect of 2nd to 5th MCPj of both hands evaluating IAS and PTI in grey scale (GS) and power Doppler (PD), and also performed the MASEI examination. In addition to the PD item of MASEI (defined as signal in bone profile or intratendon or bursa at the enthesis), PD OMERACT was evaluated as present or absent (defined as signal in the enthesis ²2 mm to the bone profile). We used a MyLab 70 XVG machine, Esaote, Genoa, Italy, with a GS 13 MHz probe and 7.1 MHz PD frequency, PRF 750 Hz and 60 Gain. 3-5 seconds videos of each MCPj and enthesis were obtained in transverse and longitudinal views for further reliability analysis. Reliability of IAS and PTI was performed by 5 readers (true US result was the consensus of at least three) and MASEI«s by 3 readers (true US result was the consensus of at least two). For qualitative reliability analysis, mean Cohen kappa was used for PD, IAS and PTI, and intraclass correlation coefficient (ICC) for MASEI based on a mean-rating of three readers, absolute-agreement, two-way mixed effect model. Statistical association between IAS, PTI and MASEI was analyzed with T student test. SPSS statistical package version 20 (SPSS Inc, Chicago, IL) was used.

Results:

Eighteen patients had PTI PD (66,7%) and same value for SIA PD. The inter-reader reliability for PTI and IAS was good with kappa values of 0.685 and 0.680 respectively. The inter-reader reliability for MASEI was excellent with ICC 0,922 (CI 95% 0,846-0,960). The inter-reader reliability for PD MASEI was ICC 0,921(CI 95% 0,855-0,963) and for PD OMERACT ICC 0.895 (CI 95% 0,802-0,949). Table 1 shows the existence of association between PTI and enthesitis identified by PD. This association was not found with IAS. PTI, both GS and PD, showed a significant relation with IAS PD (p 0.009 and p 0.037, respectively). IAS GS didn«t show any relation with PTI both PD (p 0.055) and GS (p 0.334).

Table 1. Relation between IAS and PTI with MASEI and different PD subtypes. Results are expressed as mean ± standard deviation (SD).

PTI

p value

IAS

p value

Present

Absent

Present

Absent

Mean MASEI ± SD

32,44±15,62

27±9,33

0,270

32±6,16

27,89±7,72

0,380

Mean PD MASEI ± SD

8 ±6

  3,67±3,28

0,023

6,83±6,15

6±4,5

0,694

Mean PD OMERACT ± SD

1,61±1,33

0,56±1,01

0,033

1,39±1,46

1±1

0,426

Conclusion:

The present study finds PTI to be associated with enthesitis as opposed to MCPj synovitis, which may support a functional association between PTI and enthesis, and reinforces the role of PTI in PsA as an enthesis-like lesion.


Disclosure: C. Macia-Villa, None; S. Falcao, None; H. B. Hammer, None; J. Medina, None; M. Gutierrez, None; E. De Miguel, None.

To cite this abstract in AMA style:

Macia-Villa C, Falcao S, Hammer HB, Medina J, Gutierrez M, De Miguel E. Peritenon Extensor Tendon Inflammation, Synovitis and Enthesopathy in Psoriastic Arthritis: What Is the Connection? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/peritenon-extensor-tendon-inflammation-synovitis-and-enthesopathy-in-psoriastic-arthritis-what-is-the-connection/. Accessed .
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