Salome Kristensen1, Jeppe Hagstrup Christensen2, Erik Berg Schmidt3, Jens Lykkegaard Olesen4, Martin Berg Johansen5, Kristian Bakke Arvesen6, Annette Schlemmer1. 1. Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark. 2. Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark. 3. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 4. Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark. 5. Department of Cardiology and Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND: Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability. OBJECTIVE: To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clinical examination for the detection of entheseal abnormalities. METHODS: 20 rheumatologists performed repeated assessment of enthesitis in patients with established psoriatic arthritis before and after a 2-hour training session in standardised enthesitis count according to Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Moreover, 20 patients underwent clinical and ultrasonographic examination of entheses to evaluate consensus-based elementary lesions of enthesitis. RESULTS: Training significantly increased Intra-class Correlation Coefficient for LEI from 0.18 to 0.82 and for SPARCC from 0.38 to 0.67. Ultrasound examination showed high associations between hypoechogenicity and increased thickness of the entheses and clinical examination. There was no correlation between erosions and enthesophytes found by ultrasound and clinical assessments. CONCLUSION: Training in standardised enthesitis scoring systems significantly improved clinical assessments of enthesitis and should be performed before use in daily clinical practice. Ultrasound revealed more advanced stages of enthesitis, such as enthesophytes and erosions, which were not detected with clinical examination.
BACKGROUND: Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability. OBJECTIVE: To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clinical examination for the detection of entheseal abnormalities. METHODS: 20 rheumatologists performed repeated assessment of enthesitis in patients with established psoriatic arthritis before and after a 2-hour training session in standardised enthesitis count according to Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Moreover, 20 patients underwent clinical and ultrasonographic examination of entheses to evaluate consensus-based elementary lesions of enthesitis. RESULTS: Training significantly increased Intra-class Correlation Coefficient for LEI from 0.18 to 0.82 and for SPARCC from 0.38 to 0.67. Ultrasound examination showed high associations between hypoechogenicity and increased thickness of the entheses and clinical examination. There was no correlation between erosions and enthesophytes found by ultrasound and clinical assessments. CONCLUSION: Training in standardised enthesitis scoring systems significantly improved clinical assessments of enthesitis and should be performed before use in daily clinical practice. Ultrasound revealed more advanced stages of enthesitis, such as enthesophytes and erosions, which were not detected with clinical examination.
Authors: W P Maksymowych; C Mallon; S Morrow; K Shojania; W P Olszynski; R L Wong; J Sampalis; B Conner-Spady Journal: Ann Rheum Dis Date: 2008-06-04 Impact factor: 19.103
Authors: Alesandra Florescu; Vlad Pădureanu; Dan Nicolae Florescu; Anca Bobircă; Lucian-Mihai Florescu; Ana-Maria Bumbea; Rodica Pădureanu; Anca Emanuela Mușetescu Journal: Life (Basel) Date: 2021-03-09