Power Doppler Ultrasonography Assessment of Entheses in Spondyloarthropathies: Response to Therapy of Entheseal Abnormalities

To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA). A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A...

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Bibliographic Details
Published in:	Journal of rheumatology Vol. 37; no. 10; pp. 2110 - 2117
Main Authors:	NAREDO, Esperanza, BATLLE-GUALDA, Enrique, TOYOS, Francisco Javier, CAMPOS, Cristina, GUTIERREZ-POLO, Ricardo, FERRER, Miguel Angel, MARTINEZ, Olga, DIAZ-TORNE, Cesar, GONZALEZ, Teresa, CAMPOS, Serafín, QUEIRO, Rubén, CASTANO-SANCHEZ, Manuel, GARCIA-VIVAR, M. Luz, AZNAR, Juan José, BUSTABAD, Sagrario, PAEZ-CAMINO, Manuel, TUNEU, Roser, RUIZ, Teresa, MATEO, Lourdes, PUJOL, Manuel, PONCE, Andrés, ROS, Inmaculada, GALLEGOS, Angel, GARCIA-APARICIO, Angel M, MORENO, Juan, GUMBAU, Domingo, SIANES, Manuela, POVEDA-ELICES, M. Jose, ROMERO-GOMEZ, Montserrat, RAYA, Enrique, FERNANDEZ-SUEIRO, Jose Luis, FERNANDEZ-PRADA, Manuel, GINER, Emilio, RODRIGUEZ-GOMEZ, Manuel, PINA, Maria Francisca, MEDINA-LUEZAS, Julio A
Format:	Journal Article
Language:	English
Published:	Toronto, ON Journal of Rheumatology Publishing 01-10-2010
Subjects:	Adult Biological and medical sciences Bursitis - diagnostic imaging Bursitis - drug therapy Bursitis - pathology Cardiovascular system Diseases of the osteoarticular system Diseases of the spine Female Humans Inflammatory joint diseases Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Prospective Studies Severity of Illness Index Spain Spondylarthropathies - diagnostic imaging Spondylarthropathies - drug therapy Spondylarthropathies - pathology Tendinopathy - diagnostic imaging Tendinopathy - drug therapy Tendinopathy - pathology Tendons - abnormalities Tendons - diagnostic imaging Tendons - pathology Tumor Necrosis Factor-alpha - antagonists & inhibitors Ultrasonic investigative techniques Ultrasonography, Doppler - methods Sonography Doppler ultrasound study Diseases of the osteoarticular system Rheumatology Anti-TNF Inflammatory joint disease Spondylarthropathy ANTI-TUMOR NECROSIS FACTOR Chronic Treatment Echography THERAPY MONITORING ENTHESITIS ULTRASONOGRAPHY SPONDYLOARTHROPATHIES
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Summary:	To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA). A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A PDUS examination of 14 peripheral entheses was performed by the same investigator in each center at baseline and at 6 months. The following elementary lesions were assessed at each enthesis (presence/absence): morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. Response to therapy of each elementary lesion was assessed by calculating change in the cumulative presence from baseline to 6 months. Intraobserver reliability of PDUS was evaluated by blindly assessing the stored baseline images 3 months after the real-time examination. Complete data were obtained on 197 patients who received anti-TNF therapy for 6 months. In 91.4% of the patients there were gray-scale or PD elementary lesions at baseline and at 6 months. Cumulative entheseal morphologic abnormalities, intraenthesis PD, perienthesis PD, and bursitis showed a significant decrease from baseline to 6 months (p < 0.05). There was high intraobserver reliability for all elementary lesions (interclass correlation coefficient > 0.90, p < 0.0005). Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0315-162X 1499-2752
DOI:	10.3899/jrheum.100136