Madrid Sonography Enthesitis Index Research Articles

Autoimmune thyroiditis in psoriatic disease

Objectives. To assess autoimmune thyroiditis prevalence in subclinical and clinical psoriatic arthritis (PsA). Materials and methods. 45 female adult Egyptian patients with psoriatic disease were classified into 3 equal groups: PsA, subclinical PsA, and psoriasis. A full assessment was done including Health Assessment Questionnaire, Psoriasis Area Severity Index (PASI), Leeds Enthesitis Index (LEI), PsA disease activity score (DAPSA), MAdrid Sonographic Enthesitis Index (MASEI), thyroid hormones (TSH, FT4, and FT3), thyroglobulin and thyroid peroxidase antibodies (Tg and TPO Abs), and thyroid ultrasound. Results. Thyroid abnormalities prevalence was: 33.3% with subclinical hypothyroidism, 80% with positive TPO Ab, and 46.7% with positive Tg Ab in PsA group, 26.7% with subclinical hypothyroidism, 60% with positive TPO Ab, and 33.3% with positive Tg Ab in subclinical PsA group and none in psoriasis group. PsA patients had higher TPO Ab levels compared to psoriasis patients with high statistical significant difference and lower FT3 levels compared to psoriasis patients with statistical significant difference. In subclinical PsA group, MASEI was positively correlated with TPO Ab with high statistical significance and with FT3 and Tg Ab with statistical significance, FT4 was negatively correlated with LEI with high statistical significance, and FT4 was correlated with PASI with statistical significance. In PsA group, TPO Ab was correlated with DAPSA with statistical significance. Conclusions. Autoimmune thyroiditis is more common in PsA than subclinical PsA patients. PsA patients are advised to be tested for TPO and Tg Abs. Musculoskeletal ultrasound is a screening tool to detect enthesitis in psoriasis patients.

The relationship between clinical parameters and ultrasonographic enthesitis assessment in patients with spondyloarthritis

Objectives: The study aimed to evaluate the role of ultrasonographic assessment of enthesitis in patients with spondyloarthritis (SpA) in terms of disease activity, functionality, and quality of life. Patients and methods: Ninety SpA patients (57 males, 33 females; mean age: 37.5±9.7 years; range, 18 to 60 years) were included in cross-sectional study between November 2016 and January 2017. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Short Form-12 (SF-12), and Ankylosing Spondylitis Quality of Life (ASQoL) were utilized for clinical evaluation. The clinical evaluation of enthesitis was performed with the Spondyloarthritis Research Consortium of Canada (SPARCC) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) via an algometer calibrated to 4 kg/cm2 of pressure. Ultrasound evaluation was performed according to Madrid Sonographic Enthesitis Index (MASEI). A total of 2,610 entheseal sites were examined clinically, and 1,080 were assessed ultrasonographically. Results: A significant proportion of enthesitis (463/1,080) was detected on ultrasonographic evaluation but not with clinical enthesitis score (MASES and SPARCC). Although ultrasonographic entheseal evaluation detected enthesitis in at least one enthesis of all patients, 35 of the patients had no enthesitis with clinical examination. The sites most frequently involved in the entheses were the proximal patellar tendon and Achilles tendon. The MASEI score did not correlate with the MASES, SPARCC, BASDAI, SF-12, and ASQoL but moderately correlated with the C-reactive protein (CRP) level (r=0.348), ASDAS-CRP (r=0.294), and BASFI score (r=0.244). Conclusion: The association of ultrasonography scores with CRP levels and ASDAS-CRP indicates that ultrasonography is effective in detecting inflammation. The MASEI score weakly correlates with functionality but not with quality of life. Ultrasonographic evaluation is invaluable and merits to be incorporated into SpA disease scoring system.

Clinical and ultrasonographic enthesitis assessment before and after anti-tumor necrosis factor treatment in patients with spondyloarthritis.

This study aimed to clinically and ultrasonographically evaluate enthesitis in patients with spondyloarthritis (SpA) and to determine enthesitis response to anti-tumor necrosis factor (TNF) treatment. Thirty-one SpA patients (22 males, 9 females; mean age: 39.4±10.9 years; range, 22 to 60 years) who started anti-TNF treatment due to their high disease activity were included in the cross-sectional prospective study between May 2017 and January 2018. Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Quality of Life Questionnaire, Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Metrology Index were recorded. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Score were utilized for clinical enthesitis evaluation. Patients were ultrasonographically evaluated in accordance with the Madrid Sonographic Enthesitis Index (MASEI) by a blinded sonographer. Patients were clinically and ultrasonographically assessed at baseline and in the third month after the treatment. In the initial evaluation, 24 (77.42%) of the patients had clinical enthesitis, and 30 (96.77%) of the patients had ultrasonographic enthesitis. After anti-TNF treatment, MASES, SPARCC, MASEI-structure, MASEI-thickness, MASEI-bursitis, MASEI-Doppler, MASEI-inflammatory, and MASEI-total scores significantly decreased (p<0.05). There was no significant change in MASEI-damage, MASEI-erosion, and MASEI-calcification scores following the therapy (p>0.05). Anti-TNF treatment may improve clinical and ultrasonographic enthesitis, particularly inflammatory changes. Erosions and calcifications may not ameliorate after three months of anti-TNF treatment.

Detection of subclinical enthesitis by ultrasonography in patients with psoriasis and controls.

Psoriasis is a widespread chronic inflammatory skin disease; enthesitis is inflammation of the tendon, ligament, and joint capsule insertion, prevalent in patients with psoriatic arthritis. The aim of study to evaluate the utility of the Madrid Sonography Enthesitis Index scoring system for accurate detection of subclinical enthesitis in patients with Psoriasis compared with healthy controls. Another objective was to assess increase in enthesis area and Psoriatic arthritis incidence, in a prospective 1-year follow-up. Patients aged ≥18 years who were diagnosed with Psoriasis, without musculoskeletal complaints, and who did not have any clinical sign and/or symptom of enthesitis and synovitis were included in the study. The patients and healthy controls were evaluated with ultrasonography. Ultrasonography evaluation consisted of the detection of gray-scale enthesitis and power Doppler signal in the enthesis areas. The Madrid Sonography Enthesitis Index scoring system was used to quantify the extent of the sonographic enthesis abnormalities. The mean MASEI score, structure, thickness, erosion, and calcification were significantly higher in the Psoriasis group than in the control group. The mean MASEI score, structure, erosion, and calcification measurements were significantly higher at the last examination when compared to the first examination. The triceps was the most commonly affected tendon in both groups. Ultrasonography is an important tool for diagnosis and follow-up of subclinical enthesitis in patients with psoriasis. Regardless of disease duration and severity, patients should be screened using ultrasonography at yearly intervals.

DKK-1 in psoriatic arthritis: Correlation with disease activity and enthesopathy

BackgroundPsoriatic arthritis (PsA) is a complex inflammatory disease with varied clinical characteristics. A pathognomonic characteristic of PsA is enthesitis. Entheseal inflammation ultimately leads to the production of new bone (enthesophytes). Dickkopf-related protein-1 (DKK-1) is a wingless (Wnt) inhibitor that inhibits osteoblast function. ObjectivesAssessment of the serum level of DKK-1 and its association with disease activity and enthesopathy in PsA patients. MethodsThis observational case–control study included 50 PsA patients and 50 healthy volunteers matched for age and gender. All participants were subjected to full medical history, clinical assessment, PSA activity using Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the severity and extent of psoriasis were determined by the Psoriasis Area and Severity Index (PASI). Ultrasonographic assessment of the entheses was done in accordance with the Madrid Sonographic Enthesitis Index (MASEI). Serum level of DKK-1 and correlation with disease activity and enthesopathy in PsA patients were assessed. ResultsThere was no significant difference between patients and controls regarding age and sex. The mean value of SPARCC index, DAPSA score and PASI score were 6.74±4.58, 33.24±15.26, and 8.35±10.93, respectively. There was significant difference between patients and controls regarding the serum levels of DKK-1 and MASEI score (p<0.0001). There was a significant positive correlation between serum DKK-1 and MASEI (r: 0.43527, p: 0.00158), MASEI inflammatory (r: 0.37958, p: 0.00655), and MASEI damage (r: 0.38384, p: 0.00593). ConclusionsSerum DKK-1 levels were elevated in PsA patients and were found to be correlated with MASEI score for enthesopathy.

Applicability of the MASEI index in enthesis and its association with other indices/serological markers of activity in patients with spondyloarthritis

IntroductionThe enthesis is one of the target organs in patients with spondyloarthritis (SpA), since inflammation of it, known as enthesitis, can be observed, which in many patients with spondyloarthritis could go unnoticed. ObjectiveTo find the relationship between the MASEI index (MAdrid Sonographic Enthesitis Index) in entheses and other indices/serological activity markers (such as BASDAI, DAPSA or ASDAS and ESR, CRP) in spondyloarthritis patients. Materials and methodsObservational, descriptive, and cross-sectional study. Data were collected from patients with SpA who underwent musculoskeletal ultrasound using the MASEI index and who were treated in our clinics from May 2021 to September 2021. As appropriate, the variables evaluated were described using frequency and central tendency/dispersion measures. First, we tested the normality of all the variables using a Shapiro–Wilk test. Then we studied the correlation of parametric and non-parametric numerical variables, using Pearson's and Spearman's coefficients. We used the T-Student, Mann–Whitney U, and chi-square tests for the categorical variables. ResultsWe analyzed 24 patients with SpA (with a mean age of 50.50±10.63 years), 8 women and 16 men. The variables have the following average levels: ASDAS 2.35 (±1.09); BASDAI (for those with axial involvement) 4.54 (±2.93); DAPSA (for psoriatic arthritis) 10.98 (±6.85), and total MASEI 19.88 (±14.77). We found a correlation between the total MASEI and the following variables: ASDAS (Pearson coefficient=.696), BASDAI (Spearman coefficient=.823), and DAPSA (Pearson coefficient=.823). ConclusionPatients with spondyloarthritis with more significant disease activity measured by ASDAS, BASDAI/DAPSA, and the serological markers of inflammation CRP and ESR present a higher total MASEI than patients who are controlled.

The burden of entheseal involvement in systemic lupus erythematosus: a comparative ultrasonograghic study

BackgroundImaging is crucial for identifying and diagnosis of the musculoskeletal (MSK) symptoms, which are one of the most typical manifestations of systemic lupus erythematosus (SLE). For the joints, tendons, and entheseal sites, ultrasonography has shown to be sensitive and accurate for the diagnosis of both inflammation and structural damage.AimThe goal of the current investigation is to determine the prevalence and the distribution of entheseal abnormalities in SLE patients, using musculoskeletal ultrasonography (MSUS) and to assess the relationship between entheseal sonographic changes and the SLE disease activity.Patients and methodsOne hundred sixty-eight subjects were studied (56 SLE patients, 56 psoriatic arthritis (PSA) patients, and 56 normal cases). To compare the frequency and the distribution of entheseal involvement, high-resolution MSUS was conducted to assess the entheseal sites of all patients in accordance with the Madrid Sonographic Enthesitis Index (MASEI).ResultsClinical enthesitis was detected in 39.3% of the SLE patients using the Leeds Enthesitis Index compared to 71% detected via US examination, indicating a high proportion of subclinical enthesitis in our SLE patients. The most frequently affected enthesis was the distal insertion of the patellar tendon at the tibial tuberosity which was detected in 41% of SLE patients. Enthesitis was significantly more frequent in PSA patients (100%) compared to SLE patients (71.4%) (p < 0.05) and more significantly frequent in SLE patients compared to the healthy controls (19.6%). There was a significant correlation between MASI and SLEDAI scores (r = 0.250*, p = 0.048) and the total protein in 24 h (r = 0.289*, p = 0.031). In addition, there was an inverse significant correlation between MASEI and serum albumin (r = − 0.324*, p = 0.015).ConclusionIn SLE patients, enthesitis is frequently clinical and ultrasound-verified. The most impacted enthesis is at the insertion of the quadriceps tendon. Enthesitis presence and the rise in the MASI score can serve as indicators of the severity of the SLE disease.Key Points• The most impacted entheseal site lies at the insertion of the quadriceps tendon.• The presence and the rise in MASEI score can serve as indicators of the severity of the SLE disease.

DKK-1 in psoriatic arthritis: Correlation with disease activity and enthesopathy

BackgroundPsoriatic arthritis (PsA) is a complex inflammatory disease with varied clinical characteristics. A pathognomonic characteristic of PsA is enthesitis. Entheseal inflammation ultimately leads to the production of new bone (enthesophytes). Dickkopf-related protein-1 (DKK-1) is a wingless (Wnt) inhibitor that inhibits osteoblast function. ObjectivesAssessment of the serum level of DKK-1 and its association with disease activity and enthesopathy in PsA patients. MethodsThis observational case–control study included 50 PsA patients and 50 healthy volunteers matched for age and gender. All participants were subjected to full medical history, clinical assessment, PSA activity using Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the severity and extent of psoriasis were determined by the Psoriasis Area and Severity Index (PASI). Ultrasonographic assessment of the entheses was done in accordance with the Madrid Sonographic Enthesitis Index (MASEI). Serum level of DKK-1 and correlation with disease activity and enthesopathy in PsA patients were assessed. ResultsThere was no significant difference between patients and controls regarding age and sex. The mean value of SPARCC index, DAPSA score and PASI score were 6.74±4.58, 33.24±15.26, and 8.35±10.93, respectively. There was significant difference between patients and controls regarding the serum levels of DKK-1 and MASEI score (p<0.0001). There was a significant positive correlation between serum DKK-1 and MASEI (r: 0.43527, p: 0.00158), MASEI inflammatory (r: 0.37958, p: 0.00655), and MASEI damage (r: 0.38384, p: 0.00593). ConclusionsSerum DKK-1 levels were elevated in PsA patients and were found to be correlated with MASEI score for enthesopathy.

The association between sonographic enthesitis with sonographic synovitis and tenosynovitis in psoriatic arthritis patients.

To examine the association between sonographic enthesitis with sonographic synovitis and tenosynovitis in PsA patients, and the association between sonographic enthesitis and clinical characteristics. Consecutive PsA patients that fulfilled the ClASsification criteria for Psoriatic ARthritis (CASPAR) were prospectively recruited. Each patient was evaluated by comprehensive clinical and sonographic assessment (greyscale and Doppler), the latter including 52 joints, 40 tendons and 14 entheses [according to MAdrid Sonography Enthesitis Index (MASEI) plus lateral epicondyles] performed by an experienced sonographer blinded to the clinical data. The US enthesitis score was further categorized to inflammatory (hypoechogenicity, thickening, bursitis and Doppler) and structural (enthesophytes/calcifications and erosions) subcategories. Multivariate linear regression models assessed the association between enthesitis and the selected variables. A total of 158 PsA patients [mean (s.d.) age 52.3 (13) years, 88 (55.7%) females] were analysed. Multivariate linear regression analyses showed a significant association between sonographic enthesitis and sonographic synovitis (β = 0.18, P = 0.008) and between sonographic enthesitis and sonographic tenosynovitis (β = 0.06, P = 0.02). These associations were derived from the enthesitis inflammatory subcategory of the MASEI (P < 0.05). Associations between enthesitis and synovitis were also demonstrated on the level of the elbow, knee and ankle joints (P < 0.05). In addition, sonographic enthesitis was significantly associated with older age, male sex, swollen joint count, CRP level and physical occupation. Sonographic enthesitis is associated with sonographic synovitis and tenosynovitis. The severity of sonographic enthesitis may represent a marker for inflammatory activity in other musculoskeletal domains.

Effects of TNF-α inhibition versus secukinumab on active ultrasound-confirmed enthesitis in psoriatic arthritis.

Enthesitis is a hallmark of psoriatic disease, but its clinical assessment is problematic in terms of diagnostic sensitivity and overlap with other comorbid conditions. Ultrasound is a useful tool that can give a more detailed assessment of enthesitis. Research demonstrates that those with persistent ultrasound entheseal disease are at risk of progressive articular damage. With limited data to guide choice between biologic therapy for psoriatic arthritis (PsA) patients, we wanted to assess the response of ultrasound-confirmed enthesitis to different forms of biologic therapies and study its utility in making more informed decisions. This was an open label observational study including patients aged ⩾18 years, who fulfil the classification criteria for PSA (CASPAR) and were due to commence on their first biologic therapy. The primary outcome was the change in MAdrid Sonographic Enthesitis Index (MASEI) score at 16 weeks of treatment. The MASEI score was also modified to assess the active elementary lesions (ActiveMASEI). In all, 80 PsA patients were enrolled with 75 patients completing the study [secukinumab n = 23 and tumour necrosis factor inhibitor (TNFi) n = 52]. The mean reduction in MASEI score after 16 weeks of treatment was 3.42 with TNFi versus 1.74 with secukinumab (p = 0.097). There was a significant difference in the change in the MASEIActive score for TNFi versus secukinumab (4.37 versus 2.26; p = 0.030) and this difference was more pronounced when only power Doppler signal within 2 mm of the enthesis insertion was included (4.37 versus 2.00; p = 0.007). Clinical outcomes were similar for both classes of biologic apart from a significant reduction in regards to the Dermatology Life Quality Index and Psoriasis Area and Severity Index score with secukinumab versus TNFi. We have for the first time compared the effect of ultrasound-confirmed enthesitis between different forms of biologic therapies for PsA. We have seen an overall improvement in entheseal scores for both classes of medications and demonstrated a larger reduction in active entheseal disease for TNFi versus secukinumab that merits further exploration.

Nail and enthesis assessment in patients with psoriatic disease by high frequency ultrasonography: findings from a single-centre cross-sectional study

PurposeTo characterize nail and enthesis abnormalities using high frequency ultrasound (HFUS) in patients with psoriasis (PSO), psoriatic arthritis (PSA) with PSO, and PSA sine PSO.Material and MethodsPatients with PSO, PSA with PSO, and PSA sine PSO were evaluated and compared in a cross-sectional single centre study. Nail and enthesis abnormalities were evaluated by HFUS using high frequency probes (27 MHz). After a descriptive assessment, Brown University Nail Enthesis Scale (BUNES) and Madrid Sonography Enthesitis Index (MASEI) were used to assess nail and enthesis, respectively.ResultsFifty-nine patients were enrolled (19 PSO, 22 PSA with PSO, 18 PSA sine PSO). In patients with PSO and in those with PSA and PSO, HFUS evaluation identified the following nail alterations characterised by thickened matrix, inhomogeneous echogenicity of the nail bed, and increased blood flow by power Doppler. In 38.9% patients with PSA sine PSO, a subclinical nail involvement was described. No difference was observed comparing BUNES values in three groups. In PSA patients with PSO and in those with PSA sine PSO, HFUS assessment of entheses mainly showed a hypoechoic aspect and thickness of the tendon, focal cortical erosion, and ossification. A subclinical enthesis involvement in 47.4% patients with PSO was observed. No difference was reported comparing MASEI values in three groups.ConclusionQualitative and quantitative abnormalities of nail and enthesis were demonstrated by HFUS in patients with PSO, PSA with PSO, and PSA sine PSO, suggesting a practical additional tool to be used in clinical settings. Furthermore, HFUS highlighted a subclinical nail involvement in patients with PSA sine PSO and enthesis subclinical alterations in patients with PSO.

The identification of association between ultrasonographic enthesitis and the ASAS Health Index in patients with axial spondyloarthritis.

This study aimed to evaluate association between the entheseal abnormalities in ultrasound and the Assessment of Spondyloarthritis International Society Health Index (ASAS HI) in patients with axial spondyloarthritis (axSpA). Seventy-four patients with axSpA were enrolled in this study. Ultrasonographic evaluation of entheses was performed by a blinded rheumatologist with the Madrid Sonographic Enthesitis Index (MASEI). The MASEI total score and the MASEI sub-scores (e.g., structural damage and activity scores) were calculated. The ASAS HI and the other SpA tools (e.g., Bath Ankylosing Spondylitis Disease Index, the Ankylosing Spondylitis Disease Activity Score) were used to evaluate patients' health and disease activity. Correlation and multivariate linear regression analyses were performed to assess the relationship between the MASEI and the ASAS HI. The mean score of the ASAS HI was 7.7 ± 4.6. The MASEI total score was calculated as 8.4 ± 6.8, while the mean MASEI-activity was 4.7 ± 3.6 and the mean MASEI-structural damage was 3.8 ± 4.5. There was no correlation between ASAS HI and MASEI total scores (r = 0.11, p = 0.34). However, the ASAS HI had a positive correlation with the MASEI-activity (r = 0.49, p < 0.001) and had a low negative correlation with the MASEI-structural damage (r = -0.29, p < 0.05). In the linear regression model, the MASEI-activity and MASEI-structural damage were significantly related to the ASAS HI (β = 0.72 and -0.58, respectively; R2 = 0.53 p < 0.001). This study reported that the ASAS HI score was more negatively affected by active entheseal lesions rather than structural lesions. We suggest adding the entheses evaluation with ultrasonography to other tools for monitoring the health status of patients with axSpA.

Serum interleukin-23 levels: relation to depression, anxiety, and disease activity in psoriatic arthritis patients

ObjectivesAssessment of serum levels of IL-23 in PsA patients and its correlation with depression, anxiety, and disease activity.MethodsEighty psoriatic arthritis (PsA) patients and eighty healthy volunteers matched for age and gender were included in this observational case–control study. All participants suspected to detailed history, clinical assessment, PsA activity using Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the severity and extent of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI), and ultrasonographic assessments of the entheses were examined according to the Madrid Sonographic Enthesitis Index (MASEI). Depression and anxiety were assessed by Hospital Anxiety and Depression Scale (HADS). Serum IL-23 was measured and correlated with disease activity, depression, and anxiety.ResultsThere was no significant difference between patients and controls regarding demographic data. Thirty-six PsA patients (45%) had anxiety and 28 patients (35%) had depression, while in the control group, 16 persons (20%) had anxiety and 12 (15%) had depression, with significant differences between the 2 groups (p < 0.0001). There were significant differences in HADS anxiety and depression scores between patients and controls with significant positive correlations between HADS depression, anxiety scores and IL-23, DAPSA, PASI, and MASEI scores (p < 0.05). IL-23 was positively correlated with DAPSA, PASI, and HADS scores; we observed that interleukin 23, higher DAPSA, and PASI were independently associated with depression and anxiety.ConclusionSerum interleukin-23 levels were elevated in PsA patients and were found to be correlated with depression, anxiety, and disease activity.Key Points• Psoriatic arthritis is a multidimensional disorder with psychiatric drawbacks.• Interleukin-23 is a proinflammatory cytokines that was correlated with depression and anxiety in PsA patients.• Interleukin-23 was correlated with disease activity in PsA.• Depression and anxiety were positively correlated with disease activity in PsA.

Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index

BackgroundThere is no much information about the entheseal involvement among hemodialysis (HD) patients. The aim of this study was to assess the frequency and distribution of ultrasonographic (US) entheseal alterations in HD patients and to evaluate the association between US abnormalities and both clinical and laboratory data.MethodsThis study was conducted on 41 HD patients and 23 sex- and age- matched controls. All participants were evaluated clinically for any signs of enthesopathy. Six entheses sites were scanned bilaterally using grey scale (GS) and power Doppler (PD) US and were scored using Madrid Sonography Enthesitis Index (MASEI) scoring system.ResultsIn HD patients, at least one clinical sign suggestive of enthesopathy was found in 69 (14%) of 492 entheses. HD patients had statistically significant higher scores of structural tendon abnormalities (p < 0.001), enthesis thickening (p < 0.001), bone erosions (p < 0.001) and calcification (p = 0.037) than the healthy controls. Total MASEI score was higher in HD patients than healthy controls (median;18 vs 8, p < 0.001), also, MASEI-inflammatory (median;11 vs 3, p < 0.001) and damage scores (median;6 vs 0, p < 0.001). There was a statistically significant positive association between total MASEI score and both age (p = 0.032) and duration of HD (p = 0.037). Duration of HD was predictive for both MASEI-damage component (p = 0.004) and total MASEI score (p = 0.014).ConclusionThere is a high prevalence of subclinical enthesopathy in HD patients. The entheseal US alterations is much higher in HD patients than in healthy subjects. The duration of HD is the significant predictor of enthesopathy in HD patients.

Correlation of enthesial and synovial inflammation in patients with psoriatic arthritis: Data of clinical and ultrasonographic study

Objective. Assessment of clinical manifestations and ultrasonographic signs of enthesitis (En) in patients with psoriasis (PsO) and psoriatic arthritis (PsA).Subjects and methods. The study is based on the analysis of survey data from 106 patients with PsO for the period 2018–2021, which were firstly sent by dermatologists for a consultation with a rheumatologist due to musculoskeletal pain. The duration of the period of musculoskeletal pain in the observed patients did not exceed 12 months. In addition to general clinical and laboratory examination, all patients underwent ultrasonography of painful and/or swollen joints, tendons and ligaments using a linear sensor (frequency – 12–18 MHz) of MyLab 50 (Esaote, Italy) apparatus and supplemented by Doppler energy study with a pulse frequency of 6.6 MHz. The OMERACT definitions were used to identify En, synovitis and tenosynovitis.Results and discussion. The diagnosis of PsA was established in 73.6%, osteoarthritis – in 13.2%, gout – in 8.4%, fibromyalgia – in 17.9%. Ultrasonographic signs of En were found in 67.9% of patients: signs of an active inflammatory process in enthesises (decreased echogenicity, thickening and appearance of Doppler signals) were observed in 48.7%, signs of structural damage to enthesial zones (calcifications, enthesophytes and bone erosions) in 25,6% of patients. Isolated En was found in 24.4% of patients, a combination of En and synovitis – in 32.1% of patients, a combination of En and tenosynovitis – in 20.5% of patients. The correlation between the inflammatory domain values of the ultrasoundographic enthesial index MASEI (Madrid Sonographic Enthesitis Index) and the clinical enthesial index LEI (Leeds Enthesitis Index) was 0.71 [0.58; 0.77]. There were less pronounced clinical indicators of enthesial inflammation (lower LEI index values), functional disorders of the joints (lower values of the HAQ-DI index) and laboratory signs of systemic inflammation (lower CRP values) in patients with isolated En in comparison with combination of En and synovitis. Ultrasonographic signs of structural damage of enthesises were observed in 15.4% of patients without clinical and ultrasonographic signs of active En, which may indicate the possibility of a subclinical course of enthesial inflammation in patients with PsO.Conclusion. It was demonstrated that ultrasonography has diagnostic capabilities to identify the site of the inflammatory process in patients with PsA and differentiate patients with isolated En and a combination of En and synovitis in order to select a method of differentiated anti-inflammatory therapy.

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

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.

P135 Usefulness of clinical and ultrasound indices to assess enthesis lesions in patients with inflammatory bowel diseases

Abstract Background The aim of the study was to assess existing clinical and ultrasound indices for the evaluation of enthesopathies in patients with inflammatory bowel diseases (IBD). Methods 95 pts with IBD were prospectively enrolled into the study: 55 of them with ulcerative colitis (UC) and 40 with Crohn’s disease (CD). Clinically we counted tender entheses in 46 points of the upper and lower extremities. LEI (Leeds Enthestis Index) (0–6 points), MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) (0–13 points) and the SPARCC index (Spondylarthritis Research Consortium of Canada) (0–16 points) were calculated. Ultrasound examination was performed in B-mode and PD-mode. Entheseal hypoechogenicity, entheseal thickening, presence of vascularization were considered as acute lesions. Bone erosions and enthesophytes were considered as chronic lesions. GUESS (Glasgow Ultrasound Enthesitis Scoring System) (0–36 points), MASEI (Madrid Sonography Enthesitis Index) (0–136 points) and BUSES (Belgrade Ultrasound Enthesitis Score) (0–132 points) were calculated. Spearman coefficient used to calculate correlations. Results In pts with tender ≥ 1 enthesis, the LEI was positive in 26% of patients, the MASES index - in 7%, the SPARCC index - in 18%, the US indices were positive in a larger number of patients: GUESS - in 47%, MASEI - in 40% and BUSES - 54%.A total of 6460 entheses were examined using Doppler ultrasound. The number of enthesites was 293/6460 (4.5%), the number of enthesites with vascularization was 62/6460 (1.0%), the number of erosions was 313/6460 (4.8%), the number of enthesophytes was 91/6460 (1, 4%).A direct correlation is observed between the number of enthesites and LEI indices (SR = 0.54; p = 0.00), MASES (SR = 0.42; p = 0.00), SPARCC (SR = 0.54; p = 0, 00), GUESS (SR = 0.22; p = 0.02), BUSES (SR = 0.32; p = 0.001), as well as between the number of enthesitis with vascularization and LEI indices (SR = 0.24; p = 0.017), MASES (SR = 0.34; p = 0.00), GUESS (SR = 0.23; p = 0.022), MASEI (SR = 0.32; p = 0.001), BUSES (SR = 0, 29; p = 0.003). A statistically significant relationship was found between the number of erosion and the GUESS indices (SR = 0.48; p = 0.00), MASEI (SR = 0.49; p = 0.00), BUSES (SR = 0.5; p = 0, 00), as well as between the number of enthesophytes and the GUESS indices (SR = 0.75; p = 0.00), MASEI (SR = 0.28; p = 0.00), BUSES (SR = 0.57; p = 0.00). Conclusion Acute lesion of enthesis in patients with IBD can be assessed using both clinical (LEI, MASES, SPARCC) and ultrasound indices (GUESS, MASEI, BUSES). To assess chronic lesions (erosion, enthesophyte) changes in enthesis in patients with IBD, it is preferable to use ultrasound indices.

Role of musculoskeletal ultrasound, magnetic resonance imaging, and serum chemokine C-X-C motif ligand 10 in early detection of arthritis in patients with psoriasis

Aim of the workTo assess the role of musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) and the following laboratory biomarkers; C-reactive protein (CRP), serum uric acid (SUA) and chemokine C-X-C motif ligand 10 (CXCL-10) in early detection of psoriatic arthritis (PsA) among patients with skin psoriasis (PsO). Patients and methodsA cross-sectional study was performed over 40 psoriatic patients with arthralgia and another 40 without arthralgia. All underwent MSUS of the peripheral joints, entheses, and MRI of sacroiliac joints. Madrid Sonographic Enthesitis Index (MASEI) scores were calculated. Each patient was tested for CRP, SUA, and CXCL-10. ResultsThe 80 patients median age was 46.5 (25) years (19–66 years) and were 44 females and 36 males (F: M 1.2:1) and disease duration of PsO was 4 (10.38) years (0.08–30 years). The CXCL-10 level in all the patients was 552.5 (535) pg/mL (300–1000 pg/mL). 24 (30%) of the patients had early PsA as they had active enthesitis, synovitis or sacroiliitis. 14 (17.5%) had enthesopathy without positive power Doppler (PD) signals. CXCL-10 significantly correlated with tender joint count (p < 0.001), entheseal count (p < 0.001), MASEI inflammatory score (p = 0.02) and inversely with damage score (p = 0.048). It was significantly associated with PsA development. Unlike CRP and SUA, CXCL-10 was highly sensitive (100%) for detecting PsA using a cut-off point of 552.5 pg/mL (p < 0.001). ConclusionsImaging detected PsA and subclinical enthesopathy are common among psoriatic patients. CXCL-10 is associated with abnormal PD findings. It may be a future predictive biomarker for PsA in those patients.

Characteristics of musculoskeletal ultrasound and its relationship with systemic inflammation in systemic sclerosis patients

Aim of the workTo describe musculoskeletal ultrasound (MSUS) findings in patients with systemic sclerosis (SSc) and to study their relation with cardiopulmonary and skin affection. Patient and methodsIn 50 SSc patients, hands, wrists and six entheses sites were evaluated by MSUS. Entheses were scored using the Madrid Sonography Enthesitis Index (MASEI). The modified Rodnan skin score (mRSS) was assessed. ResultsThey were 42 females/8males with a mean age 36.2 ± 11.6 years, disease duration 3.5 ± 4.2 years, 27 had limited skin affection and 23 diffuse and the mRSS was 4.1 ± 15.3. 54% had arthritis, 10% tendon friction rub, 16% joint contractures and 10% calcinosis. 18% had left ventricular hypertrophy, 34% had pulmonary hypertension, 20% had restrictive pulmonary function test (PFT) and 24% had interstial lung disease (ILD). Synovitis was detected in 58% and was significantly related to mRSS, left ventricular hypertrophy, PFT, pulmonary hypertension and ILD (p = 0.023, p = 0.03, p = 0.006, p = 0.026 and p = 0.039 respectively). Common extensor tenosynovitis was detected in 82% and was significantly related to mRSS, PFT and ILD (p = 0.019, p = 0.043 and p = 0.032 respectively). Joint erosions were detected in 36% and were significantly related to age and C-reactive protein (CRP) (p = 0.01 and p = 0.034). Enthesopathy showed a significant relation with erythrocyte sedimentation rate (ESR), CRP and mRSS (p = 0.014, p = 0.013, p = 0.025, respectively). ConclusionArticular involvement is common in SSc and underestimated by clinical examination. Synovitis is associated with cardiovascular complication in SSc. Tenosynovitis is clinically related to restrictive pulmonary function. Enthesopathy should be kept in mind in symptomatic patients with systemic sclerosis.

Serum level of bone morphogenetic protein-7 in relation to entheseal ultrasonography in ankylosing spondylitis patients

Aim of the workTo assess serum level of bone morphogenetic protein-7 (BMP-7) and to study its relation to clinical and sonographic assessment of peripheral enthesitis in ankylosing spondylitis (AS) patients. Patients and methodsThis study involved 49 AS patients and 40 matched controls. The serum BMP-7 level was determined by enzyme linked immunosorbant assay (ELISA). Entheses were assessed by musculoskeletal ultrasound (MSUS) and scored using Madrid Sonographic Enthesitis Index (MASEI). The AS disease activity score-C-reactive protein (ASDAS-CRP), Bath AS disease activity index (BASDAI) and Bath AS Functional Index (BASFI) were assessed. ResultsPatients were 45 males and 4 females with a mean age of 35.57 ± 9.71 years and median disease duration of 10 (2–28) years. US lesions were frequently found at the insertions of Achilles (76.5%), quadriceps (57.1%), plantar fascia (51%) and triceps (43.8%) tendons. Serum level of BMP-7 was significantly increased in patients (41.8 ng/ml) compared to controls (38.5 ng/ml) (p = 0.031). BMP-7 serum level significantly correlated with age (p = 0.03), disease duration (p < 0.001) and BASFI (p = 0.02) but did not correlate with ASDAS CRP, BASDAI, clinical enthesitis or total MASEI. Total MASEI correlated significantly with age, disease duration, ASDAS-CRP, BASDAI and BASFI. MASEI is a good predictor of activity in AS patients at a cut-off score of 9. ConclusionAS patients have a significant higher level of serum BMP-7 compared to control which indicates that it may play an important pathogenetic role in AS. However, this level did not correlate with either clinical or sonographic assessment of peripheral enthesitis.