Performance of 3 Enthesitis Indices in Patients with Peripheral Spondyloarthritis During Treatment with Adalimumab

Abstract

Objective.To evaluate the validity of enthesitis indices in patients with peripheral spondyloarthritis (pSpA).Methods.The ABILITY-2 study evaluated the efficacy of adalimumab (ADA) versus placebo (PBO) in patients with active pSpA over 12 weeks. Patients received open-label ADA for an additional 144 weeks. Twenty-nine enthesitis sites used in 3 enthesitis scoring systems [Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)] were assessed; discriminatory capacity and treatment response at Week 12 were calculated by standardized mean difference (SMD) and Guyatt’s effect size (ES). Sites showing resolution or new-onset enthesitis from baseline to Week 12 were analyzed.Results.Overall, 165 patients (ADA, n = 84; PBO, n = 81) were randomized; 143 had ≥ 1 enthesitis site at baseline. The LEI (SMD −0.73, ES −1.07) and SPARCC (SMD −0.56, ES −0.99) enthesitis indices showed higher discriminatory ability and treatment response than MASES (SMD −0.32, ES −0.81). At Week 12, among sites that were positive at baseline, significantly more (p < 0.05) showed resolution among patients treated with ADA versus PBO in the Achilles tendon (60.4% and 36.5%, respectively), medial epicondyle (73.2%, 48.7%), lateral epicondyle (80.6%, 52.8%), and iliac crest (73.5%, 47.2%). Among negative sites at baseline, significantly less (p < 0.05) new-onset enthesitis was observed with ADA versus PBO for Achilles tendon (3.6% and 10.9%, respectively), greater trochanter (3.4%, 14.4%), lateral epicondyle humerus (4.7%, 15.1%), medial femoral condyle (1.6%, 9.2%), and quadriceps insertion superior patella (1.5%, 7.0%).Conclusion.The LEI and SPARCC enthesitis indices showed better discriminatory capacity and treatment response in patients with pSpA versus MASES, likely because these indices contain more peripheral sites. Trial registration number: ClinicalTrials.govNCT01064856.

Characterization of Patients With Axial Spondyloarthritis by Enthesitis Presence: Data from the Corrona Psoriatic Arthritis/Spondyloarthritis Registry

“…The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), University of California, San Francisco Index, and Berlin Index have been used in axSpA studies (43)(44)(45). MASES was initially developed for identification of entheses specific for axial disease in AS (46) and has performed well in many AS and axSpA trials (45,47,48). The SPARCC Enthesitis Index was initially developed for use in both axial and peripheral SpA, including PsA (19).…”

Ентезопатії При Анкілозивному Спондиліті, Що Почався В Дитячому Та Дорослому Віці

“…При этом у 40 % от числа больных наблюдаются энтезиты [4], достоверно чаще у женщин [12]. В 11 % случаев в патологический процесс вовлекаются ахилловы сухо-жилия, в 14 % -вертлужные впадины, в 15 % -голов-ки плечевой кости, в 9 % -мыщелки бедренной кости, в 7 % -надколенники [8].…”

Assessments und Outcome-Parameter bei axialer Spondyloarthritis

“…Aufgrund der oben beschriebenen konzeptionellen Unterschiede eignet sich der MASES eher für Patienten mit einer Achsenskelettmanifestation, wohingegen LEI und SPARCC Score eine größere diskriminatorische Kapazität bei Patienten mit peripherer SpA zeigen [6]. [11].…”