title: Performance of ultrasound to monitor Achilles enthesitis in patients with ankylosing spondylitis during TNF-a antagonist therapy.
abstract: Enthesitis is considered as the primary anatomical lesion in ankylosing spondylitis (AS). We aimed to investigate the potential of ultrasound to detect early changes after TNF-a antagonist therapy of Achilles enthesitis of AS patients. One hundred AS patients with active disease, requiring TNF-a antagonist therapy, were included (etanercept n = 25, infliximab n = 25, adalimumab n = 25, non-biologic disease-modifying antirheumatic drugs (DMARDs) n = 25). Physical examination was performed to evaluate disease activity and detect Achilles enthesitis and/or retrocalcaneal bursitis. Ultrasound of the Achilles enthesitis was performed bilaterally. Follow-up examinations were performed 3 months after the initiation of therapy. Gray scale (GS) scores, Power Doppler (PD) scores, and total additive scores (TS) decreased significantly during TNF-a antagonist therapy but not in traditional non-biologic traditional DMARDs group. The bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis metrology index (BASMI), bath ankylosing spondylitis functional index (BASFI), and Maastricht ankylosing spondylitis enthesitis score (MASES) all showed significant improvements. When three different TNF-a antagonists were analyzed separately, no significant difference was observed in GS, PD, and total scores. Subclinical Achilles enthesitis, detected only with GS ultrasound, is present in a subset of AS patients and a significant improvement can be demonstrated after 3 months of TNF-a antagonist therapy. Doppler ultrasound provides a reliable estimation to monitor the therapeutic response to TNF antagonists in AS patients with Achilles enthesitis. TNF-a antagonists have been shown to be effective in decreasing ultrasound signs of enthesitis after 3 months of therapy in AS patients.
authors.affiliation: Department of Clinical Immunology, Xijing Hospital, First Affiliated Hospital of Fourth Military Medical University, Xi'an, People's Republic of China, conghuaconghua@126.com.
authors.forename: Cong-hua
authors.initials: CH
authors.lastname: Wang
authors.forename: Yuan
authors.initials: Y
authors.lastname: Feng
authors.forename: Zhen
authors.initials: Z
authors.lastname: Ren
authors.forename: Xichao
authors.initials: X
authors.lastname: Yang
authors.forename: Jun-feng
authors.initials: JF
authors.lastname: Jia
authors.forename: Meng-yao
authors.initials: MY
authors.lastname: Rong
authors.forename: Xue-yi
authors.initials: XY
authors.lastname: Li
authors.forename: Zhen-biao
authors.initials: ZB
authors.lastname: Wu
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002062:Bursitis / Q000000981:diagnostic imaging; D015331:Cohort Studies; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D018608:Ultrasonography, Doppler
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept