作者
Andrea Di Matteo,Gianluca Smerilli,Stefano Di Donato,An Ran Liu,Andrea Becciolini,Federica Camarda,Tomás Cazenave,Edoardo Cipolletta,Davide Corradini,Juan José de Agustín,Giulia Maria Destro Castaniti,Eleonora Di Donato,Luca Di Geso,E. Durán,B. Farisoğulları,Marco Fornaro,Francesca Francioso,Pamela Giorgis,Amelia Granel,Cristina Hernández‐Díaz,Rudolf Horváth,Jana Hurňáková,Diogo Jesus,Ömer Karadağ,Ling Li,Josefina Marín,María Victoria Martire,Xabier Michelena,Erica Moscioni,Laura Muntean,Matteo Piga,Marcos Rosemffet,João Rovisco,Dilek Şahın,Fausto Salaffi,L. Saraiva,Crescenzio Scioscia,Maria-Magdalena Tămaş,Shun Tanimura,Aliki Venetsanopoulou,Lucio Ventura‐Ríos,Orlando Villota,Catalina Villota‐Eraso,Paraskevi V. Voulgari,G. Vukatana,Johana Zacariaz Hereter,Helena Marzo‐Ortega,Walter Grassi,Emilio Filippucci
摘要
To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population.In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas).In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses.This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.