Sonographic subclinical entheseal involvement in dialysis patients

Abstract

Long-term dialysis treatment can be associated with several musculoskeletal complications. Entheseal involvement in dialysis patients remains rarely studied as its prevalence is underestimated due to its often asymptomatic presentation. The aims of the study were to determine the prevalence of subclinical enthesopathy in haemodialysis and peritoneal dialysis patients at the lower limb level, to investigate the inter-observer reliability of ultrasound assessment and to analyse the influence of biometric and biochemical parameters. Ultrasound examination was conducted at the entheses of the lower limbs level in 33 asymptomatic dialysis patients and 33 healthy adopting the Glasgow Ultrasound Enthesitis Scoring System (GUESS). The inter-observer reliability was calculated in 15 dialysis patients. Ultrasound found at least one sign of enthesopathy in 165 out of 330 (50%) entheses of dialysis patients. In healthy subjects, signs of enthesopathy were present in 54 out of 330 (16.3%) entheses (p < 0.0001). No power Doppler signal was detected in healthy controls, in contrast to four of 330 entheses of dialysis patients. No US signs of soft tissue amyloid deposits were found. The GUESS score was significantly higher in dialysis patients than in controls (p < 0.0001). There was no difference in terms of enthesopathy between haemodialysis and peritoneal dialysis. Dialysis duration resulted to be the most important predictor for enthesopathy (p = 0.0004), followed by patient age (p = 0.02) and body mass index (p = 0.035). Parathormone, calcium, phosphorus, C-reactive protein, cholesterol and triglycerides apparently did not play a relevant role in favour of enthesopathy. The inter-observer reliability showed an excellent agreement between sonographers with different degree of experience. Our results demonstrated a higher prevalence of subclinical enthesopathy in both haemodialysis and peritoneal dialysis patients than in healthy subjects. Follow-up will provide further information with respect to the predictive value of US findings for the development of symptomatic dialysis-related arthropathy.

Presence of enthesopathy demonstrated with ultrasonography in systemic sclerosis

“…However, we believe that the use of predefined sonographic criteria and cut-offs (even though developed for patients with SpA and stil not validated for SSc) may partly overcome this limitation. The use of these predefined cut-offs may also be argued, but this was the only possible approach to document enthesitis in SSc and used to assess enthesitis in other diseases as well [24,29,31,33,41]. We also calculated our own normotive data in healthy women in order to obtain more robust comparisons and document differences in tendon/ligament thicknesses as an important component in the diagnosis of enthesitis and calculating the MASEI.…”

“…In literature, in addition to SpA, enthesitis was investigated only in few diseases including Behçet's disease [24,25], familial Mediterranean fever [26,27], Sjögren syndrome [28], dialysis patients [29], fibromyalgia [30,31], psoriasis [9,32], inflammatory bowel disease without spondyloarthritis symptoms [33] by using US. Although musculoskeletal involvement in SSc was investigated in a few studies by using US [34][35][36] with SSc by using MRI [7].…”

Increased Enthesopathy in Patients With Familial Mediterranean Fever

“…Patients with nonspondyloarthropathy disorders such as psoriasis, Behçet disease, and familial Mediterranean fever and patients undergoing dialysis have lower enthesopathy scores (maximum mean score, ≈9); therefore, the GUESS scoring system, with a total score of 36, may be more applicable to these diseases 7 , 21 , 22 . However, GUESS has several limitations for evaluation of entheseal sites, as mentioned above.…”

Role of ultrasound in the diagnostic work-up of spondyloarthritis

“…Enthesis involvement can occur in many rheumatologic diseases such as crystal-related diseases, metabolic diseases [15,17,18,39] or in other chronic inflammatory diseases such as RA [12,15,[17][18][19]. Overlap between enthesitis (i.e.…”