Ultrasonographic detection of enthesitis and its relation to clinical manifestations among Egyptian systemic sclerosis patients

Sally A El-Leithy,Rasha M Hammoda,Nermin H El-Gharbawy,Amal I Othman

doi:10.1186/s43166-021-00099-6

Sally A El-Leithy, Rasha M Hammoda + Show 2 more

Open Access

https://doi.org/10.1186/s43166-021-00099-6

Copy DOI

Abstract

BackgroundSystemic sclerosis is a complex multi-systemic autoimmune disease with a wide range of its clinical manifestations; many systemic sclerosis (SSc) patients develop musculoskeletal manifestations during their course of illness. The aim of the study is to assess the prevalence of sonographically detected entheseal alterations in a case-control study of systemic sclerosis patients and to evaluate the relationship between the presence of these alterations and the clinical systemic manifestations. Patients and controls were evaluated using B mode and power Doppler ultrasonography to detect presence of enthesitis and were scored using Madrid Sonography Enthesitis Index (MASEI).ResultsIn SSc patients, the MASEI score was significantly higher than in control (P < 0.0001). Enthesitis was more prevalent among SSc patients compared to healthy controls, SSc patients with enthesitis had significantly more prevalence of diffuse subtypes (P < 0.001).SSc patients had significantly more prevalence of interstitial pulmonary fibrosis (IPF) (P < 0.001), digital ulcers (P < 0.001), pulmonary hypertension (P < 0.001), and arthralgia and arthritis (P < 0.001). Regarding nailfold capillaroscopy pattern, late pattern was significantly more prevalent among patients with enthesitis (P = 0.008). Age, ESR level, and modified Rodnan skin score were predictors for MASEI score.ConclusionsUltrasound features of enthesopathy were frequently presented in systemic sclerosis patients. The enthesopathy was correlated with inflammation and disease complications.

Highlights

Systemic sclerosis is a complex multi-systemic autoimmune disease with a wide range of its clinical manifestations; many systemic sclerosis (SSc) patients develop musculoskeletal manifestations during their course of illness
Values are expressed as mean ± SD and number (%), erythrocyte sedimentation rate (ESR) erythrocyte sedimentation score, Madrid Sonography Enthesitis Index (MASEI) Madrid Scoring Enthesitis Index
On displaying the best fitting multiple linear regression model for MASEI score, we found that ESR level, modified Rodnan skin score, Diffuse cutaneous involvement (dcSSc), pulmonary hypertension, arthralgia and arthritis, late pattern, and capillary width of nailfold capillary pattern were dependent predictors for MASEI score (Table 4)

Summary

Introduction

Systemic sclerosis is a complex multi-systemic autoimmune disease with a wide range of its clinical manifestations; many systemic sclerosis (SSc) patients develop musculoskeletal manifestations during their course of illness. The aim of the study is to assess the prevalence of sonographically detected entheseal alterations in a casecontrol study of systemic sclerosis patients and to evaluate the relationship between the presence of these alterations and the clinical systemic manifestations. Systemic sclerosis (SSc) is a chronic autoimmune multisystemic connective tissue disease in which pathological landmarks constitute of autoimmunity, vasculopathy, and fibrosis of skin and internal organs [1]. Many patients with scleroderma develop musculoskeletal manifestations during the course of their illness in the form of arthralgia, arthritis, myalgia, stiffness of the joints, and flexion contracture [3]. The European League against Rheumatism (EULAR) Scleroderma trial demonstrated that the degree of articular involvement is associated with systemic inflammation, disease progression, and functional disability [4]

Objectives

Methods

Results

Conclusion