Abstract
BackgroundThe presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA.MethodsA cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman’s Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease.ResultsTwo hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034).ConclusionIn this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.
Highlights
The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA)
The prevalence of enthesitis is high in Brazilian patients: among the 1505 patients included in the Brazilian Registry of Spondyloarthritis (Registro Brasileiro de Espondiloartrites - RBE), 54% had enthesitis; posterior iliac spine and Achilles tendon were the most common affected sites [4]
Disease activity was assessed in subjects with axial SpA through the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the inflammatory markers erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) including CRP (ASDAS-CRP) and ESR (ASDAS-ESR) [24, 25]
Summary
The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). The prevalence of enthesitis is high in Brazilian patients: among the 1505 patients included in the Brazilian Registry of Spondyloarthritis (Registro Brasileiro de Espondiloartrites - RBE), 54% had enthesitis; posterior iliac spine and Achilles tendon were the most common affected sites [4]. In this large cohort, enthesitis was found in 70.4% of the patients with undifferentiated SpA (USpA), 53.8% with psoriatic arthritis (PsA) and 53.5% with ankylosing spondylitis (AS) [4]
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