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Psoriatic arthritis
Original article
Achilles enthesitis defined by ultrasound is not associated with clinical enthesitis in patients with psoriatic arthritis
  1. Brigitte Michelsen1,2,
  2. Andreas P Diamantopoulos1,
  3. Dag Magnar Soldal1,
  4. Hilde Berner Hammer3,
  5. Arthur Kavanaugh4 and
  6. Glenn Haugeberg1,2,5
  1. 1Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
  2. 2Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
  3. 3Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  4. 4Department of Rheumatology, Allergy and Immunology, University of California, San Diego, USA
  5. 5Department of Rheumatology, Martina Hansens Hospital, Oslo, Norway
  1. Correspondence to Dr Brigitte Michelsen; brigitte_michelsen{at}yahoo.no

Abstract

Objective To compare clinical and ultrasonographic (US) evaluation of Achilles enthesitis in patients with psoriatic arthritis (PsA).

Methods The Achilles insertion of outpatients with PsA was examined by clinical assessment of tenderness and US evaluation of (1) inflammatory activity (defined as the presence of power Doppler signal, tendon thickening and/or hypoechogenicity) and (2) structural damage (defined as the presence of erosions, calcifications and/or enthesophytes). Univariate and multivariate logistic regression analyses were performed0.4 to explore the associations between clinical characteristics and US scores.

Results 282 Achilles tendons in 141 patients with PsA were assessed. Mean (SD) age was 52.4 (10.2) years, disease duration 9.5 (6.6) years and 50.4% were females. Palpatory tenderness was found in 88 (31.2%), US-verified inflammatory activity in 46 (16.3%) and structural damage in 148 (52.5%) of the Achilles. Total US scores, as well as their components, were similar for patients with and without palpatory tenderness. None of the clinical characteristics were associated with inflammatory activity. Age, body mass index (BMI), regular physical exercise and current use of biological disease-modifying antirheumatic drugs (bDMARDs) were associated with structural damage.

Conclusion There appears to be a lack of association between clinical and US signs of Achilles enthesitis in PsA. Age, BMI, regular physical exercise and current use of bDMARDs were associated with structural damage on US.

  • Psoriatic Arthritis
  • Ultrasonography
  • Disease Activity

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000486

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    Footnotes

    • Contributors BM, APD, DMS, HBH, AK and GH were responsible for the study design. BM, APD, DMS and GH were responsible for the data acquisition. BM analysed the data and wrote the manuscript. All authors critically revised the manuscript and approved the final version.

    • Funding This work was supported by an unrestricted grant from Pfizer (grant number WS1948310) (GH) and with a clinical research fellowship from the Hospital of Southern Norway Trust (BM).

    • Competing interests GH has received an unrestricted grant from Pfizer for this research project on psoriatic arthritis. GH is the founder of the GoTreatIt Rheuma computer software and a shareholder in DiaGraphIt manufacturing system. All other authors have declared no conflict of interest.

    • Ethics approval The study was approved by the Norwegian Regional Committees for Medical and Health Research Ethics (Regional komité for Medisinsk og helsefaglig forskningsetikk Midt-Norge 2012/101) and appropriate Institutional Review Boards.

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

    • Data sharing statement All relevant data are within the text.