The association between sonographic enthesitis and radiographic damage in psoriatic arthritis

Ari Polachek,Lihi Eder,Dafna D Gladman,Vinod Chandran,Richard Cook

doi:10.1186/s13075-017-1399-5

Abstract

BackgroundTo examine the association between sonographic enthesitis and the severity of radiographic features of damage in the peripheral and axial joints in psoriatic arthritis (PsA).MethodsA cross-sectional analysis was conducted in patients with PsA. The MAdrid Sonography Enthesitis Index (MASEI) scoring system was used to quantify the extent of sonographic entheseal abnormalities. Radiographic damage in the peripheral joints and spine was assessed by the modified Steinbrocker score (mSS), Modified New York Criteria for sacroiliitis, and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The association between MASEI and the extent of radiographic damage was assessed using negative binomial and logistic regression. The results were expressed in terms of the regression coefficient estimates and their exponentiated values (eβ) or odds ratios (OR), and 95% confidence intervals (CI).ResultsTwo hundred and twenty three patients were analyzed; 58% were males, with mean ± SD age of 55.9 ± 12.9 years and PsA duration of 16.7 ± 12.4 years. Regression analyses yielded an association between higher MASEI scores (10 units increase) and peripheral joint damage including mSS (eβ = 1.42, 95% CI: 1.15, 1.72), joint ankylosis (OR = 1.93, 95% CI: 1.37, 2.72), arthritis mutilans (OR = 1.77, 95% CI: 1.23, 2.54), and periostitis (OR = 1.41, 95% CI: 1.08, 1.84). Similarly, an association was found between higher MASEI scores and axial damage as measured by mSASSS (eβ = 2.18, 95% CI: 1.16, 4.09) and sacroiliitis (OR = 1.33, 95% CI: 1.03, 1.72).ConclusionsThe severity of sonographic enthesitis is a potential marker of radiographic peripheral and axial joint damage in PsA.

Highlights

To examine the association between sonographic enthesitis and the severity of radiographic features of damage in the peripheral and axial joints in psoriatic arthritis (PsA)
No significant changes in the results were observed. It was Ball in 1971 who primarily set the foundations for the significance of enthesitis in SpA, by suggesting that the enthesis is centrally affected in ankylosing spondylitis (AS) patients, while the synovial joint is the main target of the inflammatory involvement in rheumatoid arthritis (RA) patients [29]
Our study found an association between sonographic enthesitis and axial damage, including both spondylitis and sacroiliitis

Summary

Introduction

To examine the association between sonographic enthesitis and the severity of radiographic features of damage in the peripheral and axial joints in psoriatic arthritis (PsA). Conventional radiography, which usually shows erosions at the enthesis and enthesophytes [8], is limited by its ability to detect mainly chronic irreversible bone damage rather than active inflammation. Another modality is magnetic resonance imaging (MRI) that can demonstrate both active lesions, as entheseal thickness, soft tissue edema, and adjacent bone marrow edema, as well as chronic lesions including erosions and enthesophytes [9]. In a recent study that evaluated whole-body MRI, enthesitis was found in only 18% of the patients with PsA and the ability to read images from some locations was technically limited [10].

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