Stephanie Tom1,2, Yujie Zhong1,2, Richard Cook1,2, Sibel Zehra Aydin1,2, Gurjit Kaeley1,2, Lihi Eder3,4. 1. From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA. 2. S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto. 3. From the Division of Rheumatology, Toronto Western Hospital, Toronto; Division of Rheumatology, Women's College Hospital, Toronto; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; University of Waterloo, Waterloo, Ontario; Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Division of Rheumatology, University of Florida, Jacksonville, Florida, USA. lihi.eder@wchospital.ca. 4. S. Tom, MD, Division of Rheumatology, Toronto Western Hospital, and Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto; Y. Zhong, PhD, MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge; R. Cook, PhD, University of Waterloo; S.Z. Aydin, MD, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; G. Kaeley, MD, Division of Rheumatology, University of Florida; L. Eder, MD, PhD, Division of Rheumatology, Women's College Hospital, and Division of Rheumatology, Department of Medicine, University of Toronto. lihi.eder@wchospital.ca.
Abstract
OBJECTIVE: To assess the performance of various sonographic elemental entheseal lesions in distinguishing between psoriatic arthritis (PsA) and controls to inform the development of a novel sonographic enthesitis score for PsA. METHODS: A total of 100 age- and sex-matched individuals (50 PsA and 50 controls) were evaluated. Eleven entheseal sites were scanned bilaterally according to a standardized protocol by 2 sonographers. Based on the Outcome Measures in Rheumatology (OMERACT) definition of sonographic enthesitis, the following lesions were assessed: structural entheseal changes (hypoechogenicity), thickening, bone erosion, enthesophytes, calcification, and Doppler signal, in addition to bursitis and bone irregularities. The images were read by 2 readers blinded to the clinical information. A series of logistic regression models were used to find the optimal combination of entheseal sites and elementary lesions that distinguished PsA from controls. RESULTS: Mean age was 55 ± 10 years (59% males). The optimal model that distinguished PsA from controls included 5 elementary lesions (enthesophytes, Doppler signal, erosions, thickening, and hypoechogenicity) and 6 entheseal sites (patellar ligament insertions into the distal patella and tibial tuberosity, Achilles tendon and plantar fascia insertions into the calcaneus, common extensor tendon insertion into lateral epicondyle, and supraspinatus insertion into the superior facet of the humerus). The area under the receiver-operating characteristic curve for this model was 0.93 (95% CI 0.88-0.98). CONCLUSION: We identified potential elemental ultrasonographic abnormalities and entheseal sites that could distinguish PsA and controls. This information will contribute to the development of a new sonographic score for assessment of enthesitis in patients with PsA.
OBJECTIVE: To assess the performance of various sonographic elemental entheseal lesions in distinguishing between psoriatic arthritis (PsA) and controls to inform the development of a novel sonographic enthesitis score for PsA. METHODS: A total of 100 age- and sex-matched individuals (50 PsA and 50 controls) were evaluated. Eleven entheseal sites were scanned bilaterally according to a standardized protocol by 2 sonographers. Based on the Outcome Measures in Rheumatology (OMERACT) definition of sonographic enthesitis, the following lesions were assessed: structural entheseal changes (hypoechogenicity), thickening, bone erosion, enthesophytes, calcification, and Doppler signal, in addition to bursitis and bone irregularities. The images were read by 2 readers blinded to the clinical information. A series of logistic regression models were used to find the optimal combination of entheseal sites and elementary lesions that distinguished PsA from controls. RESULTS: Mean age was 55 ± 10 years (59% males). The optimal model that distinguished PsA from controls included 5 elementary lesions (enthesophytes, Doppler signal, erosions, thickening, and hypoechogenicity) and 6 entheseal sites (patellar ligament insertions into the distal patella and tibial tuberosity, Achilles tendon and plantar fascia insertions into the calcaneus, common extensor tendon insertion into lateral epicondyle, and supraspinatus insertion into the superior facet of the humerus). The area under the receiver-operating characteristic curve for this model was 0.93 (95% CI 0.88-0.98). CONCLUSION: We identified potential elemental ultrasonographic abnormalities and entheseal sites that could distinguish PsA and controls. This information will contribute to the development of a new sonographic score for assessment of enthesitis in patients with PsA.
Authors: Jennifer A Zellers; Bradley C Bley; Ryan T Pohlig; Nabeel Hamdan Alghamdi; Karin Grävare Silbernagel Journal: Int J Sports Phys Ther Date: 2019-09
Authors: Rusmir Husic; Angelika Lackner; Patrizia Katharina Kump; Christoph Högenauer; Winfried Graninger; Christian Dejaco Journal: Front Med (Lausanne) Date: 2021-02-12