Enthesis Ultrasound to Measure Outcome in Spondyloarthritis
Enthesis Ultrasound to Measure Outcome in Spondyloarthritis
We performed a longitudinal enthesis US study in patients with early SpA. Approval was obtained from the ethics committee of the Hospital Universitario La Paz. All patients signed an informed consent form.
The sample included the baseline visit for 146 consecutive patients attending the Early SpA Unit as part of the Esperanza programme, the referral criteria of which have been previously published. The patients were diagnosed with SpA according to accepted ASAS classification criteria. All patients completed the Spanish version of the BASDAI and the BASFI. Peripheral joint count and the presence of heel pain were also registered on the same visit day. Laboratory tests included ESR, CRP and HLA-B27. The CRP version of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the BASRI were calculated.
Patients underwent an Achilles US examination at baseline, and 6 and 12 months according to the Madrid Sonographic Enthesitis Index (MASEI). In this study, the only score was for the Achilles enthesis. The ultrasonography was performed by one rheumatologist trained in enthesis US using a Logiq 9 machine (General Electric, Wauwatosa, WI, USA) with a linear probe at 9–14 MHz. The US examiner was blinded to the status of the subject.
The elemental lesions were defined according to OMERACT definitions and the original MASEI publication. To improve precision, erosion was defined as cortical breakages with step-downs of more than 1 mm in depth and width in both the longitudinal and transverse axes. Previous studies by our group have shown good to excellent reliability results for the MASEI score with an intraclass correlation coefficient range of 0.77 (95% CI 0.20, 0.95; P < 0.01) to 0.97 (95% CI 0.90, 0.99; P < 0.0001).
The mean (s.d.) was used to describe the demographic characteristics of patients and ultrasonographic features. To compare quantitative and qualitative variables of clinical, biochemical and US data, an independent sample t test and chi-squared test were used, respectively. Pearson correlation coefficients were calculated to assess the relationships between disease activity measures and ultrasonographic features. P-values of < 0.05 were considered statistically significant. All data analyses were performed with SPSS version 17.0 software (IBM, Armonk, NY, USA).
Patients and Methods
We performed a longitudinal enthesis US study in patients with early SpA. Approval was obtained from the ethics committee of the Hospital Universitario La Paz. All patients signed an informed consent form.
Patients
The sample included the baseline visit for 146 consecutive patients attending the Early SpA Unit as part of the Esperanza programme, the referral criteria of which have been previously published. The patients were diagnosed with SpA according to accepted ASAS classification criteria. All patients completed the Spanish version of the BASDAI and the BASFI. Peripheral joint count and the presence of heel pain were also registered on the same visit day. Laboratory tests included ESR, CRP and HLA-B27. The CRP version of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the BASRI were calculated.
US Examination
Patients underwent an Achilles US examination at baseline, and 6 and 12 months according to the Madrid Sonographic Enthesitis Index (MASEI). In this study, the only score was for the Achilles enthesis. The ultrasonography was performed by one rheumatologist trained in enthesis US using a Logiq 9 machine (General Electric, Wauwatosa, WI, USA) with a linear probe at 9–14 MHz. The US examiner was blinded to the status of the subject.
The elemental lesions were defined according to OMERACT definitions and the original MASEI publication. To improve precision, erosion was defined as cortical breakages with step-downs of more than 1 mm in depth and width in both the longitudinal and transverse axes. Previous studies by our group have shown good to excellent reliability results for the MASEI score with an intraclass correlation coefficient range of 0.77 (95% CI 0.20, 0.95; P < 0.01) to 0.97 (95% CI 0.90, 0.99; P < 0.0001).
Statistical Analysis
The mean (s.d.) was used to describe the demographic characteristics of patients and ultrasonographic features. To compare quantitative and qualitative variables of clinical, biochemical and US data, an independent sample t test and chi-squared test were used, respectively. Pearson correlation coefficients were calculated to assess the relationships between disease activity measures and ultrasonographic features. P-values of < 0.05 were considered statistically significant. All data analyses were performed with SPSS version 17.0 software (IBM, Armonk, NY, USA).
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