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Clinical assessment and ultrasonography in the follow-up of enthesitis in patients with spondyloarthritis: a multicenter ultrasound study in daily clinical practice

Authors Hartung W, Nigg A, Strunk J, Wolff B

Received 8 July 2018

Accepted for publication 17 October 2018

Published 3 December 2018 Volume 2018:10 Pages 161—169


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Chuan-Ju Liu

Wolfgang Hartung,1 Axel Nigg,2 Johannes Strunk,3 Björn Wolff4

Department of Rheumatology/Clinical Immunology, Asklepios Medical Center, 93077 Bad Abbach, Germany; 2Medizinische Klinik II Kreisklinik Altötting-Burghausen, 84489 Burghausen, Germany; 3Hospital Porz am Rhein, 51149 Köln, Germany; 4AbbVie, 65189 Wiesbaden, Germany

Objectives: The aim of this study was to compare the clinical Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and an established ultrasound enthesitis score following treatment change in patients with spondyloarthritis and enthesitis with respect to the sensitivity to change and health-related quality of life.
Materials and methods: About 145 patients with active ankylosing spondylitis (n=65), psoriatic arthritis without (n=66) or with (n=14) axial involvement undergoing intensification of their treatment were included in this multicenter study. At baseline, after 3 and 6 months, 13 entheses were scored by MASES, ultrasonography was performed for 14 entheses. Assessments of clinical, laboratory and patient-reported outcome measurements were performed.
Results: During 6 months of follow-up, MASES was reduced from 5.57 to 3.12 (P<0.001), which was similar to the reduction of the power Doppler sum score from 5.47 to 2.88 (P<0.001). Both MASES and power Doppler ultrasound were responsive at the 3-month follow-up visit, as indicated by a high sensitivity to change in patients initiating anti-tumor necrosis factor treatment (–0.96 for MASES and –0.74 for power Doppler ultrasound). Improvement of enthesitis did not correlate with patient-reported outcomes.
Conclusion: Clinical assessment by MASES and power Doppler sonography as well reflects anti-tumor necrosis factor treatment response in patients with spondyloarthritis. Improvement of enthesitis did not correlate with changes in quality of life measures.

Keywords: sonography, spondyloarthritis, enthesitis, psoriatic arthritis, power Doppler

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