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Multicenter Study
. 2024 Jun 12;83(7):847-857.
doi: 10.1136/ard-2023-225443.

Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study

Andrea Di Matteo  1   2 , Gianluca Smerilli  3 , Stefano Di Donato  2 , An Ran Liu  4 , Andrea Becciolini  5 , Federica Camarda  6 , Tomas Cazenave  7 , Edoardo Cipolletta  3 , Davide Corradini  8 , Juan José de Agustín  9 , Giulia Maria Destro Castaniti  6 , Eleonora Di Donato  5 , Luca Di Geso  10 , Emine Duran  11 , Bayram Farisogullari  11 , Marco Fornaro  12 , Francesca Francioso  3 , Pamela Giorgis  7 , Amelia Granel  13 , Cristina Hernández-Díaz  14 , Rudolf Horvath  15 , Jana Hurnakova  15 , Diogo Jesus  16   17 , Omer Karadag  11 , Ling Li  18 , Josefina Marin  19 , María Victoria Martire  13 , Xabier Michelena  9 , Erica Moscioni  3 , Laura Muntean  20 , Matteo Piga  8 , Marcos Rosemffet  7 , João Rovisco  21 , Didem Sahin  2 , Fausto Salaffi  3 , Liliana Saraiva  21 , Crescenzio Scioscia  12 , Maria-Magdalena Tamas  20 , Shun Tanimura  22 , Aliki Venetsanopoulou  23 , Lucio Ventura-Rios  24 , Orlando Villota  25   26 , Catalina Villota-Eraso  26 , Paraskevi V Voulgari  23 , Gentiana Vukatana  27 , Johana Zacariaz Hereter  19 , Helena Marzo-Ortega  2 , Walter Grassi  3 , Emilio Filippucci  3
Affiliations
Multicenter Study

Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study

Andrea Di Matteo et al. Ann Rheum Dis. .

Abstract

Objectives: To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population.

Methods: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas).

Results: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses.

Conclusions: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.

Keywords: Arthritis, Psoriatic; Fibromyalgia; Osteoarthritis; Spondylitis, Ankylosing; Ultrasonography.

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Conflict of interest statement

Competing interests: ADM has received speaking fees from Janssen and has received support for attending meetings by Galapagos outside the submitted work. GS has received speaking fees and support for attending meetings by Novartis outside the submitted work. EC has received speaking fees from Novartis outside the submitted work. EDD has received speaking fees from Novartis and has received support for attending meetings by AbbVie outside the submitted work. MF has received speaking fees from Galapagos, AbbVie, Boehringer Ingelheim, Lilly and GSK and has received support for attending meetings by Pfizer outside the submitted work. XM has received speaking fees from AbbVie, Lilly Novartis, UCB and Janssen and has received support for attending meetings by UCB and Janssen outside the submitted work. MGR has received speaking fees from AbbVie, Raffo and Tecnofarma outside the submitted work. HM-O has received research grants from Janssen, Novartis, Pfizer and UCB and honoraria/speaker fees from AbbVie, Amgen, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB non-relevant to the submitted work. WG has received speaking fees from Accademia di Medicina, Janssen, Angelini Ethos, Galapagos, Biopharma and UVET outside the submitted work. EF has received speaking fees from AbbVie, Amgen, BMS, Janssen, Lilly, Novartis, Pfizer and Union Chimique Belge Pharma outside the submitted work.

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