Usefulness of ultrasonography in the assessment of peripheral enthesis in spondyloarthritis

Diffuse Peripheral Enthesitis in Metabolic Syndrome: A Retrospective Clinical and Power Doppler Ultrasound Study

OBJECTIVES

To investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH).

METHODS

Sixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group.

RESULTS

Patients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p<.00001). PD signals (15% of patients) were associated with entheseal pain (p=.0138). US scores correlated with body mass index (BMI), pain, type 2 diabetes. In 28 (46%) patients a concurrent DISH was diagnosed, correlating with older age (p<.0001), CRP (p=.0428), ESR (p=.0069) and PDUS scores (p=.0312 inflammatory, p=.0071 structural). MetS had a strong association (OR 4.375, p=.0007) with concurrent DISH.

CONCLUSIONS

Diffuse peripheral enthesitis is very common in MetS. Almost half of MetS patients can have a concurrent diagnosis of DISH; they are older, with higher inflammation, and higher PDUS enthesitis scores.

MRI of the Achilles tendon-A comprehensive pictorial review. Part one

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Presence of normal septation between subtendons may mimic an intrasubstance tear.

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MRI is superior to ultrasound in detection of partial tears.

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Ultrasound is as useful as MRI in detection of tendinopathy and full-thickness tears.

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Kager's fat pad is involved in infection more than in postoperative changes.

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The Achilles tendon xanthoma has a higher signal on T1- and T2-weighted sequences.

The normal Achilles tendon is composed of twisted subtendons separated by thin high signal septae, which are a potential pitfall on MRI because they mimic a tendon tear.

Tendinopathy and full thickness tears may be assessed effectively both on MRI and ultrasound. MRI is superior to ultrasound in detection of partial tears and for postoperative assessment. The use of fat suppression sequences allows the ability to detect focal lesions. Sagittal and coronal sections are useful for assessing the distance between stumps of a ruptured tendon. Sequences with contrast are indicated in postoperative investigations and suspicion of infection, arthritis or tumor. MRI may reveal inflammatory changes with minor symptoms long before the clinical manifestations of seronegative spondyloarthropathy. The most common non-traumatic focal lesion of the Achilles tendon is Achilles tendon xanthoma, which is manifested by intermediate or slightly higher signal on T1- and T2-weighted images compared to that in the normal Achilles tendon. Other tumors of the Achilles tendon are very rare, whereas the involvement of the tendon from tumor in adjacent structures is more frequent.

The novel MRI sequences may help to detect disorders of the Achilles tendon more specifically before clinical manifestation. Regeneration or remodeling of the Achilles tendon can be non‐invasively detected and monitored in diffusion tensor imaging. Assessment of healing is possible using T2-mapping while evaluating the tendon vascularization in intravoxel incoherent motion MRI.

Diffuse Peripheral Enthesitis in Metabolic Syndrome: A Retrospective Clinical and Power Doppler Ultrasound Study

OBJECTIVES

To investigate peripheral enthesitis with power Doppler ultrasound (PDUS) in patients presenting low back pain (LBP) and metabolic syndrome (MetS) in comparison with patients with only LBP, to correlate US scores with clinical-anthropometric characteristics, and to define any relationship between enthesitis and concurrent diffuse idiopathic hyperostosis syndrome (DISH).

METHODS

Sixty outpatients with LBP and MetS, evaluated with multi-site entheseal PDUS, scoring inflammatory and structural damage changes, were retrospectively analyzed. A group of 60 subjects with LBP, without MetS and evaluated with the same protocol, was analyzed as the control group.

RESULTS

Patients showed overweight (BMI 29.8) and low-grade inflammatory state (C-reactive protein [CRP] 0.58mg/dL, erythrosedimentation rate [ESR] 20.2mm/h). Enthesitis was demonstrated in 52 (86%) patients (17.6% entheses), and in 8 controls (13.3%) (p<.00001). PD signals (15% of patients) were associated with entheseal pain (p=.0138). US scores correlated with body mass index (BMI), pain, type 2 diabetes. In 28 (46%) patients a concurrent DISH was diagnosed, correlating with older age (p<.0001), CRP (p=.0428), ESR (p=.0069) and PDUS scores (p=.0312 inflammatory, p=.0071 structural). MetS had a strong association (OR 4.375, p=.0007) with concurrent DISH.

CONCLUSIONS

Diffuse peripheral enthesitis is very common in MetS. Almost half of MetS patients can have a concurrent diagnosis of DISH; they are older, with higher inflammation, and higher PDUS enthesitis scores.

[Usefulness and reliabitlity of musculoskeletal point of care ultrasound in family practice (1): Knee, shoulder and enthesis]

Musculoskeletal ultrasound (MSU) is a technique which has been extended to practically all medical specialties that comprise this pathology. Family Doctor (FD) has not been away from this process due to its great wide of competences, using it in different scenarios inside his common practice in which he can get profits in a reliable, efficient and effective way. Ultrasound equipment incorporation in Primary Care (PC) centers is an increasing reality, contributing to high ranges of accessibility, immediacy and clinic handle capability, and thus, together with the high prevalence in this area in locomotor apparatus, turns MSU into an strategic action for the improvement of the resolving capacity and consequently for the health care. To ensure proficiency among users, it's being necessary to define the benefits and potential risks its use can cause, as well as its different scenarios, avoiding unnecessary explorations and optimizing the investment of this resource at PC level. This paper pretends to summarize the state of the art of the musculoskeletal ultrasound and its benefits for the FD into this efficient and effective scenarios.

The prevalence of spondyloarthropathy in fibromyalgia patients

OBJECTIVE

To document the prevalence of Spondyloarthropathy (SpA) with an evaluation of patients previously diagnosed with fibromyalgia syndrome (FMS).

METHODS

The patients diagnosed with FMS before telephoned and asked three questions to determine for inflammatory back pain. American College of Rheumatology (ACR) Fibromyalgia criteria 1990 and ACR 2010 and for diagnosing patients with SpA; criteria from the European Spondyloarthropathy Study Group (ESSG), and Amor were applied.

RESULTS

FMS was diagnosed according to 1990 ACR criteria in 14 (60.8%) SpA patients who were diagnosed with SpA according to the Amor criteria alone and in 10 (43.4%) patients who were diagnosed according to ESSG criteria alone, while it was diagnosed in 9 (33.3%) patients who were diagnosed with SpA according to Amor and ESSG criteria together and in 15 (65.2%) patients diagnosed with SpA according to Amor and/or ESSG criteria. The most tenderness was experienced in the bilateral shoulder supraspinatus tendon insertion region (57.7%) and in the sacroiliac joint (40.8%). Fourteen (60.8%) patients diagnosed according to ACR 1990 and 17 (51.6%) patients diagnosed according to ACR 2010 had plantar fasciitis and/or Achilles enthesopathy on foot radiography.

CONCLUSIONS

There is a meaningful section of patients who are SpA or FMS and SpA are together in the patients thought to be FMS or the patients diagnosed with FMS according to ACR's criteria can be said.