Background:Joints and entheseal involvement is a common extraintestinal manifestation in inflammatory bowel diseases (IBD) [1]. Recent studies have shown the superiority of ultrasound over clinical findings in the evaluation of joints and periarticular tissues.Objectives:To assess of joint and entheseal involvement in IBD patients using ultrasound with Power Doppler, their correlation with IBD clinical variables and the difference between Crohn’s disease (CD) and ulcerative colitis (UC).Methods:We prospectively included 38 IBD patients into the study. Disease activity was evaluated in CD by Harvey Bradshaw, in UC - Mayo Index. Peripheral joints and entheses were imaged by ultrasound, using Samsung Accuvix A30 5-13 MHz linear array transducer. Ultrasound examination of 14 peripheral joints (hip, knee, ankle, shoulder, acromioclavicular, elbow, wrist) and 35 entheses was performed. Vascularization on them was assessed with Power Doppler (PD). Entheseal abnormalities were scored with US according to indices GUESS, MASEI and BUSES [2]. Statistical analysis was done by Mann-Whitney test and Spearman criteria by “Statistica” software.Results:In 38 patients UC was in 22 (58%), CD - in 16 (42%). The mean age of UC patients was 28 (23; 35) years, in CD - 33 (27; 36) years. The mean duration of UC was 24 (10; 48) months; CD - 66 (24; 114) months. The majority of patients had highly active disease: in UC - moderate and severe attacks in 16 pts (72%), in CD out of 16 patients, moderate and severe activity was observed in 9 (56%).Synovitis were found in 19 patients (50%), 8 patients with UC (36%), and 10 patients with CD (62%), synovitis with vascularization was detected in 7 patients (18%), five with CD (13%), two with UC (9%).Enthesitis (echogenicity reduction and thickening) was detected in 30 patients (79%), 8 (50%) pts with CD and 17 (77%) pts with UC, enthesitis with vascularization (PD) in 13 pts (34 %), 5 (31%) pts with CD and 8 (36%) pts with UC. Tenosynovitis was observed in 11 pts (29%), three (19%) with CD and 8 (36%) pts - UC, tenosynovitis with vascularization in two patients (5%), one with UC and one with CD. Structure damage (erosion, enthesophytis) were found in 23 patients (61%), 12 patients (75%) with CD and 11 (50%) patients with UC.There were no significant differences in ultrasound signs of joint and entheses damage between patients with UC and CD.We found an association between the clinical characteristics of IBD and the ultrasound signs of entheses damage: duration of the disease has a direct moderate correlation with the number of enthesitis (SR = 0.36; p = 0.026) and GUESS (SR = 0.37; p = 0.022).There was no statistically significant relationship between the severity of the attack and damage to the joints and entheses.Conclusion:The severity of joint and periarticular tissues damage is significantly correlated with the duration of the index disease and are independent of IBD activity.References:[1]The First European Evidence-based Consensus on Extra-Intestinal Manifestations in IBD // JCC. — 2016. —V. 10, № 3. — Р. 239-254.[2] Bandinelli F, Milla M, Genise S et al. Ultrasound discloses entheseal involvement in inactive and low active inflammatory bowel disease without clinical signs and symptoms of spondyloarthropathy. Rheumatology (Oxford). 2011 Jul; 50 (7): 1275-1279.Disclosure of Interests:None declared
The article is dedicated to Professor L.L. Fofanof’s scientific activity. He headed the faculty therapeutic clinic of Kazan Imperial University in 1915-1920. Being a student L.L. Fofanov was interested in pathological anatomy and physiology. His dissertation «To physiology of n. depressoris» was dedicated to studying the vasomotor center. During his visit in Germany he worked a lot. In Charite together with Professor His he studied gout and its treatment with Radium emanation. In Halle clinic under Professor Schmidt’s supervision he studied assimilation of starch in normal and pathological digestion. L.L. Fofanov also made a contribution to tuberculosis treatment: with professor V.F. Orlovskiy he studied treatment of tuberculosis with simulated pneumothorax. In his research professor L.L. Fofanov paid great attention to the issues of pathogenesis and pathogenetic substantiation of the clinical manifestation and treatment. During the World War I and Civil War he fought against typhus epidemies: he saw patients, gave lectures, studied the features of myocardial involvement. He died in 1920 from typhus.
Objective: to assess the relationship of the clinical characteristics and laboratory inflammatory markers to the ultrasound signs of synovitis and enthesitis in patients with psoriatic arthritis (PsA).Patients and methods. Examinations were made in 63 patients diagnosed with PsA according to the 2006 Classification Criteria for Psoriatic Arthritis (CASPAR) criteria. Among the patients, the majority were females (54.2%); the mean age was 42.9±10.3 years; the median (Me) PsA duration was 7 [3; 10] years; Me Disease Activity in Psoriatic Arthritis (DAPSA) was 16.5 [11.6; 25] years.All the patients underwent estimation of tender joint count, swollen joint count, tender entheseal count, inter alia using the Leeds Enthesitis Index (LEI), Maastricht Ankylosing Spondylitis Enthesis Score (MASES), and Spondyloarthritis Research Consortium of Canada (SPARCC). The investigators determined PsA activity by DAPSA and the prevalence and severity of psoriasis by the Psoriasis Area and Severity Index (PASI) and also estimated erythrocyte sedimentation rate (ESR) and high-sensitivity CRP (hs-CRP) levels. Ultrasonography was used to assess bilateral upper and lower limb joints, by calculating joint counts (JC) with synovitis signs (SJC), as well as tendon and ligament entheses (a total number of 54 in one patient), by determining the presence of vascularized enthesis count (VEC) and structurally changed enthesis count (SCEC) and using the ultrasound indices (Glasgow Ultrasound Enthesitis Scoring System (GUESS), Belgrade Ultrasound Enthesitis Score (BUSES), Madrid Sonography Enthesitis Index (MASEI), Sonographic Enthesitis Index (SEI)).Results and discussion. There were no significant differences in the frequency of damage to the upper (15.7%) and lower (19.3%) limb joints (p>0.05), whereas inflammation in the entheses of the lower limbs (23.2%) was significantly more common than that in the upper limbs (15.3%) (p<0.01). A weak relationship was established between SPARCC and SEI (r=0.276; p<0.05). A positive correlation was found between VEC and hs-CRP levels (r=0.323, p=0.01), ESR (r=0.332, p<0.01). Ultrasound imaging showed that SJC (p<0.01), enthesitis count (p<0.01), and SCEC (p<0.05) increased with age. The relationship between SCEC and GUESS (r=0.724; p<0.01) and that between the VEC and BUSES (r=0.562, p<0.01) proved to be more pronounced.Conclusion. Ultrasound imaging indicates that the entheses of the lower limbs are more frequently affected in patients with PsA. There is no relationship between DAPSA and ultrasound inflammatory changes in the joints and extra-articular structures. A strong relationship is established between enthesiseal structural and inflammatory changes and GUESS and BUSES, respectively, which allows one to recommend the use of these indices for assessing enthesitis in PsA. Entheseal vascularization associated with inflammatory markers (hs-CRP, ESR) (p<0.05) is a manifestation of PsA activity regardless of age and DAPSA.
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