Power Doppler Ultrasonography Assessment of Entheses in Spondyloarthropathies: Response to Therapy of Entheseal Abnormalities

• Published in: Journal of rheumatology 2010-10, Vol.37 (10), p.2110-2117
• Main Authors: NAREDO, Esperanza, BATLLE-GUALDA, Enrique, TOYOS, Francisco Javier, CAMPOS, Cristina, GUTIERREZ-POLO, Ricardo, FERRER, Miguel Angel, MARTINEZ, Olga, DIAZ-TORNE, Cesar, GONZALEZ, Teresa, CAMPOS, Serafín, QUEIRO, Rubén, CASTANO-SANCHEZ, Manuel, GARCIA-VIVAR, M. Luz, AZNAR, Juan José, BUSTABAD, Sagrario, PAEZ-CAMINO, Manuel, TUNEU, Roser, RUIZ, Teresa, MATEO, Lourdes, PUJOL, Manuel, PONCE, Andrés, ROS, Inmaculada, GALLEGOS, Angel, GARCIA-APARICIO, Angel M, MORENO, Juan, GUMBAU, Domingo, SIANES, Manuela, POVEDA-ELICES, M. Jose, ROMERO-GOMEZ, Montserrat, RAYA, Enrique, FERNANDEZ-SUEIRO, Jose Luis, FERNANDEZ-PRADA, Manuel, GINER, Emilio, RODRIGUEZ-GOMEZ, Manuel, PINA, Maria Francisca, MEDINA-LUEZAS, Julio A
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Bursitis - diagnostic imaging; Bursitis - drug therapy; Bursitis - pathology; Cardiovascular system; Diseases of the osteoarticular system; Diseases of the spine; Female; Humans; Inflammatory joint diseases; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Prospective Studies; Severity of Illness Index; Spain; Spondylarthropathies - diagnostic imaging; Spondylarthropathies - drug therapy; Spondylarthropathies - pathology; Tendinopathy - diagnostic imaging; Tendinopathy - drug therapy; Tendinopathy - pathology; Tendons - abnormalities; Tendons - diagnostic imaging; Tendons - pathology; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Ultrasonic investigative techniques; Ultrasonography, Doppler - methods
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.100136

To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA). A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A PDUS examination of 14 peripheral entheses was performed by the same investigator in each center at baseline and at 6 months. The following elementary lesions were assessed at each enthesis (presence/absence): morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. Response to therapy of each elementary lesion was assessed by calculating change in the cumulative presence from baseline to 6 months. Intraobserver reliability of PDUS was evaluated by blindly assessing the stored baseline images 3 months after the real-time examination. Complete data were obtained on 197 patients who received anti-TNF therapy for 6 months. In 91.4% of the patients there were gray-scale or PD elementary lesions at baseline and at 6 months. Cumulative entheseal morphologic abnormalities, intraenthesis PD, perienthesis PD, and bursitis showed a significant decrease from baseline to 6 months (p < 0.05). There was high intraobserver reliability for all elementary lesions (interclass correlation coefficient > 0.90, p < 0.0005). Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.