Abstract：
OBJECTIVE: To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population.
METHODS: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). \'Active enthesitis\' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas).
RESULTS: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses.
CONCLUSIONS: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.
METHODS: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). \'Active enthesitis\' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas).
RESULTS: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses.
CONCLUSIONS: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.
摘要：
目的：评估，在脊柱关节炎（SpA），在该人群中，风湿病学（OMERACT）超声检查病变的预后指标的鉴别价值及其与临床特征的关系。
方法：在这项涉及20个风湿病中心的多中心研究中，对413例SpA患者（轴性SpA和银屑病关节炎）和282例疾病对照（骨关节炎和纤维肌痛）进行了下肢大样本的临床和超声检查。“活动性附着点炎”定义为：（1）功率多普勒（PD）在≥1级的应用后，再加上末端增厚和/或低回声区域，或（2）PD等级>1（与周围增厚和/或低回声区域的存在无关）。
结果：在单变量分析中，除附生体/钙化外,所有OMERACT病变均与SpA显著相关.在多变量分析中，PD（OR=8.77，95％CI4.40至19.20，p<0.001）和骨侵蚀（OR=4.75，95％CI2.43至10.10，p<0.001）保留了这种相关性。在下肢中，在多变量分析中,只有跟腱与SpA显著相关(OR=1.93,95%CI1.30~2.88,p<0.001).活动性附着性炎与SpA显著相关(OR=9.20,95%CI4.21~23.20,p<0.001),与OMERACT超声病变不同,在回归分析中,它与SpA疾病活动性和严重程度的大多数临床指标一致相关.
结论：这项大型多中心研究评估了SpA附着点炎的不同超声发现的价值，确定最有区别的超声病变和SpA的末端部位。超声可以区分SpA相关的附着性炎和其他形式的附着性病理学（即，机械性附着性炎)，从而改善了对SpA中的局部参与的评估。
方法：在这项涉及20个风湿病中心的多中心研究中，对413例SpA患者（轴性SpA和银屑病关节炎）和282例疾病对照（骨关节炎和纤维肌痛）进行了下肢大样本的临床和超声检查。“活动性附着点炎”定义为：（1）功率多普勒（PD）在≥1级的应用后，再加上末端增厚和/或低回声区域，或（2）PD等级>1（与周围增厚和/或低回声区域的存在无关）。
结果：在单变量分析中，除附生体/钙化外,所有OMERACT病变均与SpA显著相关.在多变量分析中，PD（OR=8.77，95％CI4.40至19.20，p<0.001）和骨侵蚀（OR=4.75，95％CI2.43至10.10，p<0.001）保留了这种相关性。在下肢中，在多变量分析中,只有跟腱与SpA显著相关(OR=1.93,95%CI1.30~2.88,p<0.001).活动性附着性炎与SpA显著相关(OR=9.20,95%CI4.21~23.20,p<0.001),与OMERACT超声病变不同,在回归分析中,它与SpA疾病活动性和严重程度的大多数临床指标一致相关.
结论：这项大型多中心研究评估了SpA附着点炎的不同超声发现的价值，确定最有区别的超声病变和SpA的末端部位。超声可以区分SpA相关的附着性炎和其他形式的附着性病理学（即，机械性附着性炎)，从而改善了对SpA中的局部参与的评估。
