Subclinical Enthesitis in Rheumatoid Arthritis Patients and its Relation to Disease Parameters and Disease Activity

Abstract

Background: Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disorder of unknown etiology characterized by symmetrical joint synovitis and pain. RA has a wide clinical spectrum and may vary from mild nonerosive disease to severe inflammation and joint damage with extra articular manifestations. To detect enthesopathy, the European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US). Objective: To detect subclinical enthesitis in rheumatoid arthritis patients and its relation to disease parameters and disease activity. Patients and Methods: This prospective observational study included 50 adult patients diagnosed as rheumatoid arthritis according to the 2010 ACR-EULAR classification criteria for rheumatoid arthritis. The study was carried out in the Musculoskeletal Ultrasonography Unit of the Rheumatology, Physical Medicine and Rehabilitation Department, Al-Azhar University Hospitals Assiut. Results: We found that the mean age in case group was 46.3 ± 8.4 years. Females accounted for 62% (31 patients) of all patients. The disease duration ranged from one year to 15 years with a mean of 6.2 ± 1.9 years. The BMI was 19.5 ± 42 kg/m2 . Mean of disease activity evaluated by the disease activity score in 28 joints was 4.7 ± 1.5. Our findings demonstrated that prevalence of subclinical enthesitis in patients with rheumatoid arthritis was 32%. There was a statistically significant relation between 28-joint Disease Activity Score (DAS28) score and ultrasound detected enthesitis (p. value < 0.05). Conclusion: BMI, old age and long disease duration were suggested as the risk factors for subclinical enthesitis.