Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities.
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).


CONCLUSIONS
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.
Naredo
Esperanza
E
Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain. esnaredo@ser.es
Batlle-Gualda
Enrique
E
García-Vivar
M Luz
ML
García-Aparicio
Angel M
AM
Fernández-Sueiro
Jose Luis
JL
Fernández-Prada
Manuel
M
Giner
Emilio
E
Rodriguez-Gomez
Manuel
M
Pina
Maria Francisca
MF
Medina-Luezas
Julio A
JA
Toyos
Francisco Javier
FJ
Campos
Cristina
C
Gutiérrez-Polo
Ricardo
R
Ferrer
Miguel Angel
MA
Martínez
Olga
O
Díaz-Torne
Cesar
C
Gonzalez
Teresa
T
Campos
Serafín
S
Queiro
Rubén
R
Castaño-Sánchez
Manuel
M
Aznar
Juan José
JJ
Bustabad
Sagrario
S
Paez-Camino
Manuel
M
Tuneu
Roser
R
Ruiz
Teresa
T
Mateo
Lourdes
L
Pujol
Manuel
M
Ponce
Andrés
A
Ros
Inmaculada
I
Gallegos
Angel
A
Moreno
Juan
J
Gumbau
Domingo
D
Sianes
Manuela
M
Poveda-Elices
M Jose
MJ
Romero-Gómez
Montserrat
M
Raya
Enrique
E
D000328:Adult; D002062:Bursitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013030:Spain; D025242:Spondylarthropathies / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D013710:Tendons / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D018608:Ultrasonography, Doppler / Q000379:methods*
D014409:Tumor Necrosis Factor-alpha