title: Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities.
abstract: 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.
authors.affiliation: Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain. esnaredo@ser.es
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.forename: Enrique
authors.initials: E
authors.lastname: Batlle-Gualda
authors.forename: M Luz
authors.initials: ML
authors.lastname: García-Vivar
authors.forename: Angel M
authors.initials: AM
authors.lastname: García-Aparicio
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Fernández-Sueiro
authors.forename: Manuel
authors.initials: M
authors.lastname: Fernández-Prada
authors.forename: Emilio
authors.initials: E
authors.lastname: Giner
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodriguez-Gomez
authors.forename: Maria Francisca
authors.initials: MF
authors.lastname: Pina
authors.forename: Julio A
authors.initials: JA
authors.lastname: Medina-Luezas
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Toyos
authors.forename: Cristina
authors.initials: C
authors.lastname: Campos
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gutiérrez-Polo
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Ferrer
authors.forename: Olga
authors.initials: O
authors.lastname: Martínez
authors.forename: Cesar
authors.initials: C
authors.lastname: Díaz-Torne
authors.forename: Teresa
authors.initials: T
authors.lastname: Gonzalez
authors.forename: Serafín
authors.initials: S
authors.lastname: Campos
authors.forename: Rubén
authors.initials: R
authors.lastname: Queiro
authors.forename: Manuel
authors.initials: M
authors.lastname: Castaño-Sánchez
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Aznar
authors.forename: Sagrario
authors.initials: S
authors.lastname: Bustabad
authors.forename: Manuel
authors.initials: M
authors.lastname: Paez-Camino
authors.forename: Roser
authors.initials: R
authors.lastname: Tuneu
authors.forename: Teresa
authors.initials: T
authors.lastname: Ruiz
authors.forename: Lourdes
authors.initials: L
authors.lastname: Mateo
authors.forename: Manuel
authors.initials: M
authors.lastname: Pujol
authors.forename: Andrés
authors.initials: A
authors.lastname: Ponce
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ros
authors.forename: Angel
authors.initials: A
authors.lastname: Gallegos
authors.forename: Juan
authors.initials: J
authors.lastname: Moreno
authors.forename: Domingo
authors.initials: D
authors.lastname: Gumbau
authors.forename: Manuela
authors.initials: M
authors.lastname: Sianes
authors.forename: M Jose
authors.initials: MJ
authors.lastname: Poveda-Elices
authors.forename: Montserrat
authors.initials: M
authors.lastname: Romero-Gómez
authors.forename: Enrique
authors.initials: E
authors.lastname: Raya
mesh_terms: 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*
chemical_list: D014409:Tumor Necrosis Factor-alpha