Estimation of peripheral enthesitis with ultrasonogrpahy and power doppler in spondyloarthropathies patients

Abstract EN

Objective: To estimate the frequency and severity of peripheral enthesitis among the different subtypes of SPA and correlate it with clinical finding in those patients.

Subjects : the study was performed on 3 subtypes of SPA, group I included 12 Ankylosing spondylitis patients, group II included 9 psoriatic patients, while group III included 6 patients with Reiter’s syndrome or reactive arthritis.

Methodology : all the patients were clinically examined and the following ethereal insertion sites were examined at first clinically then by US and power Doppler which were: greater trochanter, patella (at insertions of the quadriceps femora's and patellar tendon), Achilles tendon and planter fascia insertions on the calcaneus and any abnormal findings suggestive of enteritis by both methods of evaluation were recorded.

Results : there was statistical significant difference between the 3 groups of the study as regard various clinical manifestations except for enteritis, dactylitis and uveitis.

Also, by clinical examination 48 sites out of 270 entheses (17.7 %) were found abnormal in 12 patients (44.4%), while 105 entheses (38.8%) were considered abnormal by US and power Doppler in 25 patients (92.6 %), the 2 patients without enthesitis had psoriasis with no significant variation in the frequency of entheses involvement among the different subtypes of SPA, also the pattern of distribution appeared to be independent of SPA subtype.

By classifying the patients according to the clinical distribution of skeletal symptoms, no major variation in the proportion of abnormal enthuses identified by US was observed between these different forms.

In contrast, the vascularization pattern was dependent on the clinical presentation of SPA, there was more severe pattern of US involvement in the peripheral form of SPA and there was higher incidence of ethereal vascularization (which represented isolated vascular changes occurring during the initial phase of enteritis) in patients with mixed form than the other 2 forms.

While no statistical significant difference in the distribution of severity pattern for non-vascularized enteritis which reflects inactive lesions.

Conclusion : The use of B-mode US and power Doppler allow better visualization and detection of enteritis which is useful for both diagnosis and follow up in SPA patients.