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. 2018 Aug 22;4(2):e000686.
doi: 10.1136/rmdopen-2018-000686. eCollection 2018.

Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort

Cecile Poulain  1 , Maria Antonietta D'Agostino  2   3 , Severine Thibault  4 , Jean Pierre Daures  4 , Salah Ferkal  5 , Philippe Le Corvoisier  5 , Alain Rahmouni  6 , Damien Loeuille  7 , Maxime Dougados  8   9 , Pascal Claudepierre  1   10
Affiliations

Can power Doppler ultrasound of the entheses help in classifying recent axial spondyloarthritis? Data from the DESIR cohort

Cecile Poulain et al. RMD Open. .

Abstract

Early diagnosis of axial spondyloarthritis (axSpA) remains a challenge due to the lack of specificity of clinical symptoms and variable prevalence of axial imaging findings permitting a definite diagnosis. Power Doppler ultrasonography (PDUS) of the entheses has demonstrated to be a potential useful tool for the classification and diagnostic management of early SpA independently of the phenotype.

Objectives: To assess the classification value (sensitivity and specificity) of PDUS-defined enthesitis for identifying patients fulfilling Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA (ASAS+) in patients with recent inflammatory back pain (IBP) (the DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort).

Methods: Baseline PDUS was performed at eight entheseal sites, and PDUS enthesitis was defined by the presence of vascularisation at entheseal insertion.

Results: 402 patients from the DESIR cohort underwent a PDUS evaluation. PDUS enthesitis was detected in 58 (14.4%) patients of whom 40 (14.2%) belonged to the ASAS+ patients and 18 (17%) to the ASAS- patients. The sensitivity of PDUS enthesitis was 13.9% and the specificity was 83.5%, with a positive predictive value of 69% and 26.8% of negative predictive value for meeting ASAS criteria for axSpA. Of the 18 ASAS- patients with positive PDUS, 59% fulfilled Amor's criteria, 88% European Spondyloarthropathy Study Group criteria and 59% both.

Conclusions: In a cohort of patients with recent IBP, the prevalence of PDUS enthesitis was low (14.4%); however, its specificity for classifying patients as axSpA according to ASAS criteria was high (83.5%). PDUS enthesitis might be of additional value for classifying as patients with axSpA IBP who do not fulfil ASAS criteria.

Keywords: ankylosing spondylitis; enthesitis; spondyloarthritis; tendinitis; ultrasonography.

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Conflict of interest statement

Competing interests: PC has received consulting fees, speaking fees and/or honoraria from Pfizer, Abbvie, Roche-Chugai, Bristol-Myers Squibb, MSD, Janssen, Novartis, Celgene and UCB (less than US$10 000 each) and has been an investigator for Roche-Chugai, Sanofi Aventis, Abbvie, Pfizer, Celgene, UCB and BMS. MAD’A has received consulting fees and or speaking fees (less than US$10 000 each) from BMS, Roche-Chugai, Abbvie, MSD, Novartis and Pfizer and she is the PI of an academic multicentre clinical study which received a grant from Pfizer. MD has received consulting fees and or speaking fees (less than US$10 000 each) from BMS, Roche-Chugai, Abbvie, MSD, Novartis and Pfizer and he is the PI of an academic multicentre clinical study which received a grant from Pfizer.

Figures

Figure 1
Figure 1
PDUS scan of an Achilles’ enthesis complex showing enthesitis (erosion of calcaneum with Doppler signal (star)), tendinitis (arrow) and bursitis (+). PDUS, power Doppler ultrasonography.
Figure 2
Figure 2
Achilles enthesitis with Doppler signal within 2 mm from bony cortex.
Figure 3
Figure 3
Smallest detectable Doppler signal considered for the diagnosis of PDUS enthesitis in the DESIR cohort. DESIR, DEvenir des Spondylarthropathies Indifférenciées Récentes; PDUS, power Doppler ultrasonography.
See this image and copyright information in PMC

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