Ultrasonographic evaluation of Achilles tendon: Is there any difference between ankylosing spondylitis, non‐radiographic axial spondyloarthropathy and controls?

Abstract

Purpose:The aim is to evaluate Achilles tendon enthesopathy with ultrasound (US) in ankylosing spondylitis (AS) and non-radiographic axial SpA (nr-axSpA) patients and controls, and compare these groups in terms of associations between disease activity parameters and ultrasonographic Achilles enthesitis signs. Methods:A total of 24 AS and 20 nr-axSpA patients fulfilling the Assessment in Spondyloarthritis International Working Group criteria for axSpA and 30 controls were enrolled. Demographic characteristics, erythrocyte sedimentation rate, C-reactive protein (CRP), human leukocyte antigen (HLA)-B27, Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index, Maastricht AS Enthesitis Score (MASES), AS Disease Activity Score-CRP, modified Stoke AS Spine Score (m-SASSS) scores and ultrasonographic findings were noted. Results: HLA-B27 positivity, extra-articular and peripheral involvement, disease activity, functional status, mean m-SASSS, ultrasonographic gray scale (GS) andtotal scores were similar between AS and nr-axSpA groups. In GS, tendon echotexture scores were significantly different across all groups (0.812 ± 0.384 in AS, 0.575 ± 0.466 in nr-axSpA, 0.017 ± 0.091 in controls; P < .001). Entheseal calcification scores were similar in AS and nr-axSpA patients, and higher than controls (P = .001).Bone profile scores were similar in patients with AS and nr-axSpA, and higher than controls (P = .010). When the correlations between US findings and disease activity and functional status were considered, power Doppler US (PDUS) and MASES total scores were positively correlated in the AS group (P = .045; r = .41). Conclusion: AS and nr-axSpA patients were found to be similar in various clinical, functional, and US findings indicating that these 2 entities are different phenotypic reflections of the same disease spectrum. The positive correlation between PDUS and MASES scores in AS patients substantiate the performance of MASES in evaluation of entheseal activity. K E Y W O R D S achilles, ankylosing spondylitis, enthesitis, non-radiographic axial spondyloarthritis, ultrasound

Ultrasound Assessment of Entheses and Correlations Between Disease Activity and Ultrasound Scores in Ankylosing Spondylitis: A Cross Sectional Study

“…More entheseal areas were evaluated and more information was gathered. In the present study, the entheses included the upper limbs, lower limbs, trunk, and ACW, whereas most studies have only focused on the upper and lower limbs [13][14][15]. The ndings of the present study have shown that the three entheses of AT, SCJ, and CCJ were more common in the AS group compared to the control group.…”

“…However, there is no clear agreement on which sites should be evaluated for enthesitis. Most studies have focused on the lower limbs [11,13,14], while some others investigated the upper limbs [15,16]. However, few articles pay attention to the anterior chest wall (ACW) [17].…”

Prevalence of HLA-B27 in Turkish Patients with Ankylosing Spondylitis and Non-radiographic Axial Spondyloarthritis

“…Although HLA-B27 positivity among the Turkish patients diagnosed with AS has been investigated before, this is the first study evaluating the HLA-B27 positivity among the patients with AS and nr-axSpA in Turkey. [11][12][13][14] The fact that nr-axSpA patients were included in our analysis is the strength of our study. However, it is known that the different subtypes (HLA B2705, B2701, B2703, B2707, B2708, B2710, B2713, B2714, B2715, B2719 and B2725) and its distribution differ in terms of geography.…”

“…10 Although there are studies regarding the HLA-B27 prevalence in patients with AS in Turkey, there is insufficient information on the HLA-B27 prevalence in patients with nr-axSpA. [11][12][13][14] Therefore, in this study, we aimed to evaluate; (1) the prevalence of HLA-B27 positivity among patients with AS and nr-axSpA, and (2) its association with disease activity, which was evaluated through the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP).…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part I: Extraarticular Pathologies

“…Whether and to what extent US can distinguish between enthesitis of different origins including local non-inflammatory conditions needs to be established [144][145][146][147][148][149][150][151][152][153].…”