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Reliability of high-resolution ultrasonography in the assessment of Achilles tendon enthesopathy in seronegative spondyloarthropathies
  1. Emilio Filippucci (emilio_filippucci{at}yahoo.it)
  1. Rheumatology Department, Università Politecnica delle Marche, Ancona, Italy
    1. Sibel Zehra Aydin (drsibelaydin{at}gmail.com)
    1. Rheumatology Department, Marmara University Medical School, Istanbul, Turkey
      1. Omer Karadag
      1. Rheumatology Department, Hacettepe University Medical School, Ankara, Turkey
        1. Fausto Salaffi
        1. Rheumatology Department, Università Politecnica delle Marche, Ancona, Italy
          1. Marwin Gutierrez
          1. Rheumatology Department, Università Politecnica delle Marche, Ancona, Italy
            1. Haner Direskeneli
            1. Rheumatology Department, Marmara University Medical School, Istanbul, Turkey
              1. Walter Grassi
              1. Rheumatology Department, Università Politecnica delle Marche, Ancona, Italy

                Abstract

                Objective: The present study was mainly aimed at investigating the interobserver and intraobserver reproducibility of US in the assessment of Achilles tendon enthesopathy in patients with seronegative spondyloarthropathies (SpA).

                Methods: Twenty-eight patients with a SpA diagnosis according to the European Spondyloarthropathy Study Group criteria were included. Patients female/male ratio was 1.8 (18/10), mean age was 42 (range 25–75) years and mean disease duration was 9 (range 1–35) years. Mean (SD) BASDAI and BASFI scores were 32.4 (14.5) and 26.3 (9.2) respectively. Bilateral Achilles tendon US examinations were carried out independently by three investigators using a MyLab70 XVG (Esaote Biomedica, Genoa – Italy), equipped with a broadband 6-18 MHz linear probe. Each Achilles tendon was scanned for assessing the presence/absence of US findings indicative of enthesopathy according to OMERACT preliminary definition. The same findings were also scored on a 3-grade semiquantitative scoring system on which investigators reached a consensus prior to the study. Total additive scores per Achilles tendon were calculated.

                Results: Moderate to excellent interobserver and intraobserver agreements were found for most of the US findings indicative of enthesopathy. Similar results were obtained using semiquantitative assessments, being weighted kappa values estimating the interobserver and intraobserver agreements for soft tissue inflammation 0.696 and 0.816, respectively and for tissue damage 0.711 and 0.901, respectively.

                Conclusion: US assessment of Achilles tendon enthesopathy in patients with SpA, using the OMERACT preliminary definition, was found reliable. Bone irregularity and entheseal hypoechogenicity were the most difficult abnormalities to agree on.

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