Session Information
Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Along with emergence of the term of ‘non-radiographic axial SpA’ (nr-AxSpA), studies comparing AS and nr-AxSpA in terms of genetic, epidemiologic, and clinical issues have accrued. The aim of this study is to evaluate the achilles tendon enthesopathy with ultrasound (US) in AS and nr-AxSpA patients and controls. We also aimed to compare these groups in terms of associations between disease activity parameters and ultrasonographic achilles enthesitis signs.
Methods:
A total of 24 AS and 20 nr-AxSpA patients fulfilling the ASAS (Assesment of Spondyloarthritis International Society) criteria for AxSpA, and 30 controls were enrolled. All SpA patients were newly diagnosed and on NSAID treatment. Demographic characteristics and ESR, CRP, HLA-B27, and indices of BASDI BASFI, BASMI, MASES (Maastrich Ankylosing Spondylitis Enthesitis Score), ASDAS-CRP, and mSASSS (Modified Stoke Ankylosing Spondilitis Spinal Score) scores were noted. Ultrasonographic evaluation of achilles tendon was performed in prone position by two rheumatologists blind to patients’ clinical data. For the distribution of the categorical data, chi square and Fisher’s exact test were used. For comparison of mean or median values of continuous values Mann Whitney U and ANOVA tests were used. Kruskal-Wallis Test was used for comparison of non-parametric data. Spearman’s correlation analysis was applied for determination of correlations between clinical and US parameters.
Results:
The mean age and body mass index were similar between AS and nr-axSpA groups. However, the mean age of the control group was lower. HLAB27 positivity, extra-articular and peripheral involvement, disease activity, functional status, mean mSASSS, ultrasonographic gray scale (GS) and total scores (TS) were similar between AS and nr-axSpA groups. In GS, tendon echotexture scores were significantly different across all groups (0.81±0.38 in AS, 0.58±0.47 in nr-axSpA, 0.17±0.91 in controls; p=0.000). Entheseal calcification and bone profile scores were similar in AS and nr-axSpA groups but higher than controls (p:0.01). When the correlations between US findings and disease activity and functional status were considered, Power Doppler (PD) score and MASES total scores were positively correlated in AS group (p=.045; r: 0.41).
Conclusion:
In this study, AS and nr-axSpA patients were found to be similar in various clinical, functional, and radiologic aspects indicating that these two entities are different phenotypic reflections of the same disease spectrum rather than two distinct diseases. The positive correlation between PD and MASES scores in AS patients substantiate the performance of MASES in evaluation of entheseal activity.
Table 1: Ultrasound findings of AS and nr-axSpA patients and controls
|
n |
Mean |
SD |
Median |
Min. |
Max. |
p |
||
|
GS |
AS |
24 |
5.92 |
3.46 |
4.50 |
2.00 |
14.00 |
< 0.001 |
|
nr-AxSpA |
20 |
4.05 |
2.80 |
3.50 |
0.00 |
9.00 |
||
|
Control |
30 |
1.73 |
1.89 |
1.00 |
0.00 |
7.00 |
||
|
PD |
AS |
24 |
0.29 |
1.08 |
0.00 |
0.00 |
5.00 |
0.12 |
|
nr-AxSpA |
20 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
||
|
Control |
30 |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
||
|
Total Score |
AS |
24 |
6.21 |
4.25 |
4.50 |
2.00 |
19.00 |
< 0.001 |
|
nr-AxSpA |
20 |
4.05 |
2.80 |
3.50 |
0.00 |
9.00 |
||
|
Control |
30 |
1.73 |
1.89 |
1.00 |
0.00 |
7.00 |
GS: Gray Scale; PD: Power Doppler; SD: standard deviation
To cite this abstract in AMA style:
Vahidfar S, Sunar I, Ataman S, Yılmaz G, AZARABADI JM, Bölükbaşı A. Ultrasonographic Evaluation of Achilles Tendon in Early Axial Spondyloarthropathy: Is There Any Difference between Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthropathy? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/ultrasonographic-evaluation-of-achilles-tendon-in-early-axial-spondyloarthropathy-is-there-any-difference-between-ankylosing-spondylitis-and-non-radiographic-axial-spondyloarthropathy/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonographic-evaluation-of-achilles-tendon-in-early-axial-spondyloarthropathy-is-there-any-difference-between-ankylosing-spondylitis-and-non-radiographic-axial-spondyloarthropathy/