Value of the Power Doppler ultrasound findings for diagnosis of the peripheral enthesitis in patients with spondyloarthritis

Uvod. Ultrazvuk ima vaţnu ulogu za dijagnozu perifernog entezitisa kod bolesnika sa spondiloartritisima (SpA) jer je dokazano da je senzitivniji i specifičniji dijagnostički metod od kliničkog nalaza entezitisa. Cilj: Utvrditi razlike u ultrazvučnim karakteristikama entezitisa kod bolesnika sa SpA u odnosu na bolesnike sa reumatoidnim artritisom (RA) i bolesnike sa mehanički uslovljenim entezitisom (MRE). Metodologija: Istraţivanje je sprovedeno kao prospektivna, duplo slepa studija. Istraţivanje je obuhvatilo 127 bolesnika sa postavljenom dijagnozom entezitisa od strane ordinirajućeg reumatologa. MeĎu ispitivanim bolesnicima bilo je 75 bolesnika sa SpA, 26 bolesnika sa RA i 26 bolesnika sa MRE. Bolesnici su dolazili na 4 predviĎene vizite u toku 6 meseci. Pored demografskih podataka, istraţivanje je obuhvatilo analiziranje kliničkih, laboratorijskih i radiografskih nalaza, pokazatelja aktivnosti bolesti i funkcionalne sposobnosti bolesnika. Na svakoj viziti klinički pregled obavljao je jedan reumatolog, a ultrazvučno ispitivanje enteza dvoje ultrasonografista. Reumatolog i ultrasonografisti nisu znali osnovnu dijagnozu bolesti, mesto entezitisa, laboratorijske, radiografske, kliničke i ultrazvučne nalaze. Klinički i ultrasonografski su ispitivane obostrano sledeće enteze: plantarne fascije (PF), Ahilove tetive (AT), gornjeg pripoja ligamenta patele (GLP), donjeg pripoja ligamenta patele (DLP), tetive kvadricepsa (TK), tetive gluteusnih mišića (TGM), zajedničke tetive ekstenzora podlaktice (ZTEP), zajedničke tetive fleksora podlaktice (ZTFP) i tetive tricepsa (TT). Na svakoj viziti, u toku istraţivanja, oboje ultrasonografista su kod svakog od 127 bolesnika pregledali svaku od navedenih 18 enteza u longitudinalnoj i transverzalnoj ravni. Ultrazvučne znake entezitisa predstavljali su: (1) povećana debljina enteze, (2) hipoehogenost sa istovremeno prisutnim gubitkom normalne fibrilarne strukture enteze, (3) entezofit, (4) PD signal u nivou enteze (< 2mm od korteksa kosti) i (5) erozija...Introduction. Ultrasound (US) has an important role for diagnosis of the enthesitis in spondyloarthritis (SpA) because it is proved to be a more sensitive and more specific diagnostic tool than clinical examination. Objectives. To identify the differences in ultrasound characteristics of enthesitis in patients (pts) with SpA compared to patients with rheumatoid arthritis (RA) and patients with mechanically related enthesitis (MRE). To determine the relationship between ultasound and Power Doppler (PD) findings of the peripheral enthesitis with clinical and radiographic findings of the peripheral enthesitis. Methods. This prospective, blinded study included 127 pts with enthesitis (76 pts with SpA, 26 pts with rheumatoid arthritis, 25 pts with mechanically-related enthesitis). Demographic, clinical, laboratory anad radiographic findings, as well as values of the diseases activity and functional indexes were summarized. Data were summarized by descriptive statistics (frequencies, mean and standard deviation). The entheses of the plantar fascia (PF), the Achilles tendon (AT), the patellar tendon distal (PTD) and the patellar tendon proximal (PTP) insertion, the quadriceps tendon (QT), the gluteus tendons (GT) on the greater trochanter, the common extensor tendon (CET) on the lateral epicondyle, the common flexor tendon (CFT) on the medial epicondyle, and the triceps tendon (TT) were examined bilaterally by clinical and US examination. Clinical rheumatologist and two US operators were blind to clinical diagnosis, sites of the enthesitis, laboratory, radiographic and US findings. The operators assessed enthesis thickness, echogenicity, enthesophytes, PD signal and erosions. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine the predictive value of each enthesitis lesion for diagnosis of SpA. The best predictive value for SpA was accomplished when absence and presence of increased thickness, hypoechogenicity and enthesophytes were scored as 0 and 1; absence and presence of PD and erosions were scored as 0 and 4..