Ultrasound detection of enthesitis in patients with spondyloarthritis
Authors:
J. Hurňáková 1; R. Horváth 1,2; J. Gatterová 1; K. Pavelka 1
Authors place of work:
Revmatologický ústav a Revmatologická klinika 1. LF UK v Praze
1; Oddělení revmatologie dětí a dospělých, FN Motol, Praha
2
Published in the journal:
Čes. Revmatol., 23, 2015, No. 3, p. 91-99.
Category:
Review Article
Summary
Enthesitis – inflammation of the origin and insertion of tendons, joint capsules, ligaments and aponeuroses – is the typical and often dominant sign in spondyloarthropathies. Clinical examination of enthesitis may lack sensitivity and raise doubts even among experienced clinicians.
The authors aimed to represent ultrasound examination of enthesis which precisely visualize its structure, assess its thickness, echogenicity and presence of Power Doppler signal. Typical US signs of acute or active enthesitis are: hypoechogenicity, thickening (with or without mixed echotexture, and with or without blurring of the tendon margins), and Doppler signal at the cortical bone insertion. Erosions and cortical irregularities, enthesophytes and calcification belong to structural signs of chronic and/or inactive US enthesitis. Localization of Power Doppler enables distinguishing active inflammatory process (enthesitis) from degenerative or mechanic enthesopathy.
In recent years, several enthesitis scoring indices have been developed. First and so far mostly used is the GUESS index (Glasgow ultrasound entesitis scoring system), others are MASEI (Madrid sonographic enthesitis index) and SEI (Spanish enthesitis index). Enthesitis scoring systems has led to standardization and quantification of ultrasound findings typical for enthesitis and enabled to investigate prevalence of enthesitis in patients with spondyloarthropathy. Previous studies demonstrated a high prevalence of entesitis by ultrasonography (45–60%), while significantly lower prevalence was observed by clinical examination (14–22%). Most frequently affected enthesis according to the mentioned reports were: Achilles tendon, quadriceps tendon, distal part of ligamentum patellae, proximal part of ligamentum patellae and plantar fascia. Authors describe also the use of ultrasound follow-up for monitoring therapeutic response of biologic and non-biologic agents. The last part of this article is dedicated to the role of ultrasound vs. MRI in detecting enthesitis.
Key words:
Enthesitis, spondyloarthropathy, ultrasonography
Zdroje
1. Ball J Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis 1971, 30(3): 213–223.
2. Ball J The enthesopathy of ankylosing spondylitis. Br J Rheumatol 1983, 22(4 Suppl 2): 25–28.
3. McGonagle D, Gibbon W, Emery P Classification of inflammatory arthritis by enthesitis. Lancet 1998, 352(9134): 1137–1140.
4. McGonagle D, Khan MA, Marzo-Ortega H, O'Connor P, Gibbon W, Emery P Enthesitis in spondyloarthropathy. Curr Opin Rheumatol 1999, 11(4): 244–250.
5. D'Agostino MA, Olivieri I Enthesitis. Best Pract Res Clin Rheumatol 2006, 20(3): 473–486.
6. McGonagle D, Marzo-Ortega H, O'Connor P, Gibbon W, Hawkey P, Henshaw K, Emery P Histological assessment of the early enthesitis lesion in spondyloarthropathy. Ann Rheum Dis 2002, 61(6): 534–537.
7. McGonagle D, Lories RJ, Tan AL, Benjamin M The concept of a "synovio-entheseal complex" and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 2007, 56(8): 2482–2491.
8. Benjamin M, McGonagle D The anatomical basis for disease localisation in seronegative spondyloarthropathy at entheses and related sites. J Anat 2001, 199(Pt 5): 503–526.
9. Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S The "enthesis organ" concept: why enthesopathies may not present as focal insertional disorders. Arthritis Rheum 2004, 50(10): 3306–3313.
10. Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, Landewe R, van ver Tempel H, Mielants H, Dougados M, van der Heijde D Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003, 62(2): 127–132.
11. Filippucci E, Aydin SZ, Karadag O, Salaffi F, Gutierrez M, Direskeneli H, Grassi W Reliability of high-resolution ultrasonography in the assessment of Achilles tendon enthesopathy in seronegative spondyloarthropathies. Ann Rheum Dis 2009, 68(12): 1850–1855.
12. Frediani B, Falsetti P, Storri L, Allegri A, Bisogno S, Baldi F, Marcolongo R Ultrasound and clinical evaluation of quadricipital tendon enthesitis in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol 2002, 21(4): 294–298.
13. Genc H, Cakit BD, Tuncbilek I, Erdem HR Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects. Clin Rheumatol 2005, 24(3): 272–277.
14. Gibbon WW, Long G Ultrasound of the plantar aponeurosis (fascia). Skeletal Radiol 1999, 28(1): 21–26.
15. De Simone C, Guerriero C, Giampetruzzi AR, Costantini M, Di Gregorio F, Amerio P: Achilles tendinitis in psoriasis: clinical and sonographic findings. J Am Acad Dermatol 2003, 49(2): 217–222.
16. Balint PV, Sturrock RD Inflamed retrocalcaneal bursa and Achilles tendonitis in psoriatic arthritis demonstrated by ultrasonography. Ann Rheum Dis 2000, 59(12): 931–933.
17. D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum 2003, 48(2): 523–533.
18. D'Agostino M A, Aegerter P, Jousse-Joulin S, Chary-Valckenaere I, Lecoq B, Gaudin P, Brault I, Schmitz J, Dehaut FX, Le Parc JM et al: How to evaluate and improve the reliability of power Doppler ultrasonography for assessing enthesitis in spondylarthritis. Arthritis Rheum 2009, 61(1): 61–69.
19. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA et al Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005, 32(12): 2485–2487.
20. Terslev L, Naredo E, Iagnocco A, Balint PV, Wakefield RJ, Aegerter P, Aydin SZ, Bachta A, Hammer HB, Bruyn GA et al Defining enthesitis in spondyloarthritis by ultrasound: results of a Delphi process and of a reliability reading exercise. Arthritis Care Res (Hoboken) 2014, 66(5): 741–748.
21. Gandjbakhch F, Terslev L, Joshua F, Wakefield RJ, Naredo E, D'Agostino MA Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther 2011, 13(6): R188.
22. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD: Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 2002, 61(10): 905–910.
23. de Miguel E, Munoz-Fernandez S, Castillo C, Cobo-Ibanez T, Martin-Mola E Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis. Ann Rheum Dis 2011, 70(3): 434–439.
24. Alcalde M, Acebes JC, Cruz M, Gonzalez-Hombrado L, Herrero-Beaumont G, Sanchez-Pernaute O A sonographic enthesitic index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis 2007, 66(8): 1015–1019.
25. de Miguel E, Cobo T, Munoz-Fernandez S, Naredo E, Uson J, Acebes JC, Andreu JL, Martin-Mola E Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis 2009, 68(2): 169–174.
26. Borman P, Koparal S, Babaoglu S, Bodur H Ultrasound detection of entheseal insertions in the foot of patients with spondyloarthropathy. Clin Rheumatol 2006, 25(3): 373–377.
27. Spadaro A, Iagnocco A, Perrotta FM, Modesti M, Scarno A, Valesini G: Clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis. Rheumatology (Oxford) 2011, 50(11): 2080–2086.
28. Ruta S, Gutierrez M, Pena C, Garcia M, Arturi A, Filippucci E, Marcos JC Prevalence of subclinical enthesopathy in patients with spondyloarthropathy: an ultrasound study. J Clin Rheumatol 2011, 17(1): 18–22.
29. Lehtinen A, Taavitsainen M, Leirisalo-Repo M Sonographic analysis of enthesopathy in the lower extremities of patients with spondylarthropathy. Clin Exp Rheumatol 1994, 12(2): 143–148.
30. Lehtinen A, Leirisalo-Repo M, Taavitsainen M Persistence of enthesopathic changes in patients with spondylarthropathy during a 6-month follow-up. Clin Exp Rheumatol 1995, 13(6): 733–736.
31. D'Agostino MA, Breban M, Said-Nahal R, Dougados M Refractory inflammatory heel pain in spondylarthropathy: a significant response to infliximab documented by ultrasound. Arthritis Rheum 2002, 46(3):840-841, author reply 841–843.
32. Naredo E, Batlle-Gualda E, Garcia-Vivar ML, Garcia-Aparicio AM, Fernandez-Sueiro JL, Fernandez-Prada M, Giner E, Rodriguez-Gomez M, Pina MF, Medina-Luezas JA et al Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. J Rheumatol 2010, 37(10): 2110–2117.
33. Balint PV, D'Agostino MA Spondyloarthritis: a journey within and around the joint. Rheumatology (Oxford) 2012, 51 Suppl 7: vii13–17.
34. Kamel M, Eid H, Mansour R Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging. J Rheumatol 2003, 30(4): 774–778.
35. McGonagle D, Marzo-Ortega H, O'Connor P, Gibbon W, Pease C, Reece R, Emery P The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy. Arthritis Rheum 2002, 46(2): 489–493.
36. Eshed I, Bollow M, McGonagle DG, Tan AL, Althoff CE, Asbach P, Hermann KG MRI of enthesitis of the appendicular skeleton in spondyloarthritis. Ann Rheum Dis 2007, 66(12): 1553–1559.
37. Ruta S, Acosta Felquer ML, Rosa J, Navarta DA, Garcia Monaco R, Soriano ER: Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients. Clin Rheumatol 2015, 34(1): 125–132.
38. Aydin SZ, Karadag O, Filippucci E, Atagunduz P, Akdogan A, Kalyoncu U, Grassi W, Direskeneli H Monitoring Achilles enthesitis in ankylosing spondylitis during TNF-alpha antagonist therapy: an ultrasound study. Rheumatology (Oxford) 2010, 49(3): 578–582.
Štítky
Dermatology & STDs Paediatric rheumatology RheumatologyČlánok vyšiel v časopise
Czech Rheumatology
2015 Číslo 3
Najčítanejšie v tomto čísle
- Ultrasound detection of enthesitis in patients with spondyloarthritis
- Ocular complications in patients with rheumatoid arthritis
- Life threatening manifestations of connective tissue diseases and vasculitides