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Abstract
Background Enthesitis is a hallmark of ankylosing spondylitis (AS), while entheseal involvement in AS is not always detected by clinical examination. Ultrasonography (US) has proved to be a highly sensitive and non-invasive tool, especially for detecting and assessing entheseal abnormalities. Several scoring systems are relevant for monitoring these abnormalities, while quantification of enthesitis involvement still remains to reach a consensus.
Objectives To examine associations between US assessments (B-mode and power Doppler) of enthesitis and traditional assessments of disease activity, and to examine sensitivity to changes of US assessment as well as traditional clinical variables during treatment with a biological agent.
Methods A total of 20 patients (median (range) age 25.5(18-43) years, disease duration 1.5 (0.6-8) years, 3 women) with AS initiating Enbrel treatment (50mg once a week) were examined at baseline and after 1, 2 and 3 months with US using semiquantitative scoring of 6 pairs entheseal sites. All patients underwent evaluation using the BASDAI, patient’s and physician’s visual analogue scale (VAS) on global disease activity (0-100mm), ESR and CRP. Clinical enthesopathy was defined by the presence of at least one of the following findings: 1) spontaneous pain; 2) swelling of the enthesis; 3) tenderness.
Results Clinical and US examination reveled at least one abnormal enthesis in 9 (45%) and 19 (95%) AS patients, respectively. The US assessments were partially associated with clinical and laboratory variables of disease activity (Table 1). The patients improved across all variables during follow-up and US assessments were highly sensitive to changes during treatment with biological agents. The improvement of US score continued during 2-3 month, although patients were basically in remission (Table 2).
Conclusions US heavily improves detection of structural and inflammatory abnormalities of the enthesis in AS than physical examination for better evaluation of enthesitis. US could be useful for assessment of AS activity and guiding the clinical medications.
Disclosure of Interest None Declared