Power Doppler Ultrasonography Assessment of Entheses in Spondyloarthropathies: Response to Therapy of Entheseal Abnormalities
Por:
Naredo, E, Batlle-Gualda, E, Garcia-Vivar, ML, Garcia-Aparicio, AM, Fernandez-Sueiro, JL, Fernandez-Prada, M, Giner, E, Rodriguez-Gomez, M, Pina, MF, Medina-Luezas, JA, Toyos, FJ, Campos, C, Gutierrez-Polo, R, Ferrer, MA, Martinez, O, Diaz-Torne, C, Gonzalez, T, Campos, S, Queiro, R, Castano-Sanchez, M, Aznar, JJ, Bustabad, S, Paez-Camino, M, Tuneu, R, Ruiz, T, Mateo, L, Pujol, M, Ponce, A, Ros, I, Gallegos, A, Moreno, J, Gumbau, D, Sianes, M, Poveda-Elices, MJ, Romero-Gomez, M, Raya, E
Publicada:
1 oct 2010
Resumen:
Objective. To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA).
Methods. 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.
Results. 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).
Conclusion. 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. (First Release September 1 2010; J Rheumatol 2010:37:2110-17; doi:10.3899/jrheum.100136)
Filiaciones:
Naredo, E:
Hosp Univ Severn Ochoa, Dept Rheumatol, Madrid 28033, Spain
Batlle-Gualda, E:
Hosp Univ Alicante, Alicante, Spain
Garcia-Vivar, ML:
Hosp Basurto, Bilbao, Spain
Garcia-Aparicio, AM:
Hosp Virgen Salud, Toledo, Spain
Fernandez-Sueiro, JL:
Hosp Juan Canalejo, La Coruna, Spain
Fernandez-Prada, M:
Hosp Univ Guadalajara, Guadalajara, Spain
Giner, E:
Hosp Clin Univ Lozano Blesa, Zaragoza, Spain
Rodriguez-Gomez, M:
Complejo Hosp Ourense, Orense, Spain
Pina, MF:
Hosp Rafael Mendez, Murcia, Spain
Medina-Luezas, JA:
Complejo Hosp Palencia, Palencia, Spain
Toyos, FJ:
Hosp Virgen Macarena, Seville, Spain
Campos, C:
Hosp Gen Univ Valencia, Valencia, Spain
Gutierrez-Polo, R:
Clin San Miguel, Pamplona, Spain
Ferrer, MA:
Hosp Univ Virgen de la Nieves, Granada, Spain
Martinez, O:
Hosp Virgen de la Concha, Zamora, Spain
Diaz-Torne, C:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gonzalez, T:
Inst Prov Rehabil, Madrid, Spain
Campos, S:
Hosp Virgen del Rocio, Seville, Spain
Queiro, R:
Hosp Univ Cent Asturias, Oviedo, Spain
Castano-Sanchez, M:
Hosp Virgen Arrixaca, Merida, Venezuela
Aznar, JJ:
Hosp Merida, Merida, Venezuela
Bustabad, S:
Hosp Univ Tenerife, Tenerife, Spain
Paez-Camino, M:
Hosp Jerez, Jerez de la Frontera, Spain
Tuneu, R:
Hosp Althaia Xarsa Assistencial Manresa, Barcelona, Spain
Ruiz, T:
Hosp Sierrallana, Santander, Spain
Mateo, L:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Pujol, M:
Hosp Mutua de Terrassa, Barcelona, Spain
Ponce, A:
Hosp Gen Granollers, Barcelona, Spain
Ros, I:
Hosp Son Llatzer, Palma De Mallorca, Spain
Gallegos, A:
Hosp Univ Getafe, Madrid, Spain
Moreno, J:
Hosp Santa Maria del Rosell, Cartagena, Spain
Gumbau, D:
Hosp de la Plana, Villarreal, Spain
Sianes, M:
Hosp Gen Albacete, Albacete, Spain
Poveda-Elices, MJ:
Hosp Univ Tarragona Joan XXIII, Tarragona, Spain
Romero-Gomez, M:
Hosp Univ Reina Sofia, Cordoba, Spain
Raya, E:
Hosp Clin San Cecilio, Granada, Spain
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