RT Journal Article
SR Electronic
T1 Chronic but not inflammatory changes at the Achilles’ tendon differentiate patients with peripheral spondyloarthritis from other diagnoses – Results from a prospective clinical trial
JF RMD Open
JO RMD Open
FD EULAR
SP e000541
DO 10.1136/rmdopen-2017-000541
VO 3
IS 2
A1 Xenofon Baraliakos
A1 Uta Kiltz
A1 Heiner Appel
A1 Friedrich Dybowski
A1 Manfred Igelmann
A1 Ludwig Kalthoff
A1 Claudia Klink
A1 Dietmar Krause
A1 Ertan Saracbasi
A1 Elmar Schmitz-Bortz
A1 Feras Rahmeh
A1 Juergen Braun
YR 2017
UL http://rmdopen.bmj.com/content/3/2/e000541.abstract
AB Background Imaging has an essential role in the new spondyloarthritis (SpA) classification criteria for axial but not for peripheral manifestations. We evaluated the impact of imaging findings for identification and treatment decisions in patients with peripheral spondyloarthritis (pSpA) and controls (non-SpA).Methods Patients with pSpA (Assessment of SpA international Society criteria, n=30) and non-SpA (n=30), aged <45 years, with painful heels or knees, were recruited. Conventional radiography, grey-scale ultrasound including power Doppler (US/PDUS) and MRI of symptomatic areas were performed to assess inflammatory and structural changes. Mann-Whitney U test was used for group comparisons.Results In total, 105 painful entheses (71 heels, 34 knees) in 60 patients were examined. Differences between diagnoses were found for symptom duration (pSpA: 17.2±27.5 vs non-SpA: 4.4±4.3 months), human leucocyte antigen B27 prevalence (67% vs 13%) and gender distribution (53.3% vs 20% male, respectively), all P<0.05. Logistic regression analysis for baseline differences showed that chronic changes (erosions and calcification) in the heel were more frequent in pSpA versus non-SpA by US/PDUS (62.5% vs 28.6% patients and 59.5% vs 26.5% entheses, P<0.05). Inflammatory changes in heel or knee by US/PDUS and MRI could not differentiate between non-SpA and pSpA.Conclusions Differentiation between pSpA and non-SpA was only possible based on structural but not inflammatory changes in the heels and knees of symptomatic patients. US/PDUS was superior to MRI for this purpose. These findings imply that pSpA is associated with erosive changes at enthesitic sites, while inflammation and susceptibility are of minor influence for the development of erosions and calcification to pSpA.