Article Text

PDF
Extended report
How to diagnose spondyloarthritis early? Accuracy of peripheral enthesitis detection by power Doppler ultrasonography
  1. Maria Antonietta D'Agostino1,
  2. Philippe Aegerter2,
  3. Karine Bechara1,
  4. Carine Salliot1,
  5. Olivia Judet3,
  6. Maria Sole Chimenti1,
  7. Dominique Monnet4,
  8. Jean-Marie Le Parc1,
  9. Paul Landais5,
  10. Maxime Breban1,6
  1. 1Department of Rheumatology, Université de Versailles St-Quentin-en Yvelines-Paris Ile de France-Ouest, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
  2. 2Department of Public Health, Université de Versailles St-Quentin-en Yvelines-Paris Ile de France-Ouest, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
  3. 3Department of Radiology, Université de Versailles St-Quentin-en Yvelines-Paris Ile de France-Ouest, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
  4. 4Department of Ophthalmology, Université Paris Descartes, AP-HP, Cochin Hospital, Paris, France
  5. 5Department of Biostatistics and Computer Sciences, Université Paris Descartes- APHP, Necker Hospital, Paris, France
  6. 6Institut Cochin, INSERM U1016, CNRS UMR 8104, University Paris-Descartes, France
  1. Correspondence to Maxime Breban, Department of Rheumatology, Université de Versailles St-Quentin-en Yvelines-Paris Ile de France-Ouest, AP-HP, Ambroise Paré Hospital, 92100 Boulogne-Billancourt, France; maxime.breban{at}apr.aphp.fr

Abstract

Objective Early diagnosis of spondyloarthritis (SpA) is sometimes difficult owing to the lack of reliable diagnostic criteria. The objective of this study was to determine the diagnostic accuracy of detecting enthesitis by power Doppler ultrasonography (PDUS) in patients with suspected SpA.

Methods A prospective single-centre cohort study was performed in patients with symptoms suggestive of SpA (inflammatory back pain, arthritis, enthesitis or dactylitis, HLAB27+ uveitis) who underwent clinical examination, pelvic x-ray, MRI of lumbar spine/sacroiliac joints, HLA-B typing and other tests judged useful for diagnosis. Blinded PDUS examination of seven sites of enthesitis was performed at baseline. The gold standard was the diagnosis made by the referring rheumatologist according to the development of symptoms and findings, blinded to PDUS results, during routine follow-up for up to 2 years.

Results Between November 2002 and October 2004, 118 patients were included in the study. After 2 years a definite diagnosis was retained for 99 patients (51 SpA and 48 non-SpA). PDUS detection of at least one vascularised enthesis provided good predictive value for diagnosing SpA (sensitivity 76.5%; specificity 81.3%; positive likelihood ratio 4.1; OR 14.1; p<0.0001). Vascularised enthesitis detected by PDUS and Amor's criteria were the only independent contributors to a diagnosis of SpA in multivariate logistic regression (c-index=0.87). Alternatively, CART analysis resulted in a highly sensitive and specific diagnostic tree by combining PDUS with Amor's criteria.

Conclusions PDUS appears to be a valuable first-line diagnostic tool to confirm a diagnosis of SpA.

Statistics from Altmetric.com

Footnotes

  • Funding This study was supported by a grant from the French Society of Rheumatology (SFR) in 2004 (15 000 Euros) used for data acquisition, creation of a database and analysis.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ambroise Paré Hospital, Boulogne-Billancourt France.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.