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Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients

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Abstract

The objective of this study is to evaluate the responsiveness to therapy change of a global ultrasound (US) assessment in the short-term monitoring of spondyloarthritis (SpA) patients with peripheral involvement. Consecutive SpA patients with both clinical peripheral involvement and active disease (initiating or changing therapy) were included. All patients underwent both clinical and US assessment in day entering the study and after 3 months of follow-up. Peripheral global US assessment included the recognition of abnormal inflammatory findings at joint, tendon, and entheseal level according tostandardized scanning methods. A total of 34 patients completed both basal and 3-month follow-up assessments. Acute phase reactants, both erythrocyte sedimentation rate and C-reactive protein, tenderness (68) and swollen (66) joint counts, Bath Ankylosing Spondylitis Disease Activity Index and Health Assessment Questionnaire decreased significantly at 3-month follow-up. Total score for the global US assessment also decreased significantly between basal and 3-month follow-up assessment [mean difference, 12.33 (IC 95 %, 9.23–15.42); p < 0.0001]. All individual component, joint, tendon, and enthesis scores, also showed a significant decrease during the follow-up period. A high degree of intra-observer reliability was found for the global US assessment (ICC [95 % CI]: 0.977 [0.961–0.993]). This global US assessment, including joints, tendons, and entheses, showed a good responsiveness to clinical changes and might be useful for monitoring SpA patients with peripheral involvement.

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References

  1. Zochling J, Braun J, van der Heijde D (2006) Assessments in ankylosing spondylitis. Best Pract Res Clin Rheumatol 20(3):521–537. doi:10.1016/j.berh.2006.03.011

    Article  PubMed  Google Scholar 

  2. Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Geher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Bohm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65(4):442–452. doi:10.1136/ard.2005.041137

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Machado P, Landewe R, Lie E, Kvien TK, Braun J, Baker D, van der Heijde D (2011) Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis 70(1):47–53. doi:10.1136/ard.2010.138594

    Article  PubMed  Google Scholar 

  4. Heldmann F, Dybowski F, Saracbasi-Zender E, Fendler C, Braun J (2010) Update on biologic therapy in the management of axial spondyloarthritis. Curr Rheumatol Rep 12(5):325–331. doi:10.1007/s11926-010-0125-y

    Article  CAS  PubMed  Google Scholar 

  5. van der Heijde D, Sieper J, Maksymowych WP, Dougados M, Burgos-Vargas R, Landewe R, Rudwaleit M, Braun J (2011) 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis 70(6):905–908. doi:10.1136/ard.2011.151563

    Article  PubMed  Google Scholar 

  6. Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (2011) 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 70(6):896–904. doi:10.1136/ard.2011.151027

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Naredo E, Collado P, Cruz A, Palop MJ, Cabero F, Richi P, Carmona L, Crespo M (2007) Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum 57(1):116–124. doi:10.1002/art.22461

    Article  PubMed  Google Scholar 

  8. Naredo E, Moller I, Cruz A, Carmona L, Garrido J (2008) Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum 58(8):2248–2256. doi:10.1002/art.23682

    Article  PubMed  Google Scholar 

  9. Hartung W, Kellner H, Strunk J, Sattler H, Schmidt WA, Ehrenstein B, Fleck M, Backhaus M (2012) Development and evaluation of a novel ultrasound score for large joints in rheumatoid arthritis: one year of experience in daily clinical practice. Arthritis Care Res (Hoboken) 64(5):675–682. doi:10.1002/acr.21574

    Article  Google Scholar 

  10. Hammer HB, Kvien TK (2011) Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther 13(3):R78. doi:10.1186/ar3341

    Article  PubMed Central  PubMed  Google Scholar 

  11. Iagnocco A, Filippucci E, Perella C, Ceccarelli F, Cassara E, Alessandri C, Sabatini E, Grassi W, Valesini G (2008) Clinical and ultrasonographic monitoring of response to adalimumab treatment in rheumatoid arthritis. J Rheumatol 35(1):35–40

    PubMed  Google Scholar 

  12. Filippucci E, Iagnocco A, Salaffi F, Cerioni A, Valesini G, Grassi W (2006) Power Doppler sonography monitoring of synovial perfusion at the wrist joints in patients with rheumatoid arthritis treated with adalimumab. Ann Rheum Dis 65(11):1433–1437. doi:10.1136/ard.2005.044628

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. de Miguel E, Cobo T, Munoz-Fernandez S, Naredo E, Uson J, Acebes JC, Andreu JL, Martin-Mola E (2009) Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis 68(2):169–174. doi:10.1136/ard.2007.084251

    Article  PubMed  Google Scholar 

  14. de Miguel E, Munoz-Fernandez S, Castillo C, Cobo-Ibanez T, Martin-Mola E (2011) Diagnostic accuracy of enthesis ultrasound in the diagnosis of early spondyloarthritis. Ann Rheum Dis 70(3):434–439. doi:10.1136/ard.2010.134965

    Article  PubMed  Google Scholar 

  15. D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M (2003) Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum 48(2):523–533. doi:10.1002/art.10812

    Article  PubMed  Google Scholar 

  16. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD (2002) Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 61(10):905–910

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Aydin SZ, Karadag O, Filippucci E, Atagunduz P, Akdogan A, Kalyoncu U, Grassi W, Direskeneli H (2010) Monitoring Achilles enthesitis in ankylosing spondylitis during TNF-alpha antagonist therapy: an ultrasound study. Rheumatology (Oxford) 49(3):578–582. doi:10.1093/rheumatology/kep410

    Article  CAS  Google Scholar 

  18. Naredo E, Batlle-Gualda E, Garcia-Vivar ML, Garcia-Aparicio AM, Fernandez-Sueiro JL, Fernandez-Prada M, Giner E, Rodriguez-Gomez M, Pina MF, Medina-Luezas JA, Toyos FJ, Campos C, Gutierrez-Polo R, Ferrer MA, Martinez O, Diaz-Torne C, Gonzalez T, Campos S, Queiro R, Castano-Sanchez M, Aznar JJ, Bustabad S, Paez-Camino M, Tuneu R, Ruiz T, Mateo L, Pujol M, Ponce A, Ros I, Gallegos A, Moreno J, Gumbau D, Sianes M, Poveda-Elices MJ, Romero-Gomez M, Raya E (2010) Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities. J Rheumatol 37(10):2110–2117. doi:10.3899/jrheum.100136

    Article  PubMed  Google Scholar 

  19. Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, Burgos-Vargas R, Collantes-Estevez E, Davis J, Dijkmans B, Dougados M, Emery P, van der Horst-Bruinsma IE, Inman R, Khan MA, Leirisalo-Repo M, van der Linden S, Maksymowych WP, Mielants H, Olivieri I, Sturrock R, de Vlam K, Sieper J (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis 68(6):770–776. doi:10.1136/ard.2009.108217

    Article  CAS  PubMed  Google Scholar 

  20. Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sorensen IJ, Ozgocmen S, Roussou E, Valle-Onate R, Weber U, Wei J, Sieper J (2009) The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783. doi:10.1136/ard.2009.108233

    Article  CAS  PubMed  Google Scholar 

  21. Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, Dougados M, Huang F, Gu J, Kirazli Y, Van den Bosch F, Olivieri I, Roussou E, Scarpato S, Sorensen IJ, Valle-Onate R, Weber U, Wei J, Sieper J (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70(1):25–31. doi:10.1136/ard.2010.133645

    Article  CAS  PubMed  Google Scholar 

  22. Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54(8):2665–2673. doi:10.1002/art.21972

    Article  PubMed  Google Scholar 

  23. Citera G, Arriola MS, Maldonado-Cocco JA, Rosemffet MG, Sanchez MM, Goni MA, Spindler A, Lucero E, Berman A (2004) Validation and crosscultural adaptation of an argentine spanish version of the health assessment questionnaire disability index. J Clin Rheumatol 10(3):110–115. doi:10.1097/01.rhu.0000128732.58292.cd

    Article  PubMed  Google Scholar 

  24. van der Heijde DM, van ‘t Hof M, van Riel PL, van de Putte LB (1993) Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol 20(3):579–581

    PubMed  Google Scholar 

  25. Healy PJ, Helliwell PS (2008) Measuring clinical enthesitis in psoriatic arthritis: assessment of existing measures and development of an instrument specific to psoriatic arthritis. Arthritis Rheum 59(5):686–691. doi:10.1002/art.23568

    Article  PubMed  Google Scholar 

  26. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291

    CAS  PubMed  Google Scholar 

  27. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, Wakefield RJ, Manger B (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60(7):641–649

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA, Kane D, O'Connor PJ, Manger B, Joshua F, Koski J, Grassi W, Lassere MN, Swen N, Kainberger F, Klauser A, Ostergaard M, Brown AK, Machold KP, Conaghan PG (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32(12):2485–2487

    PubMed  Google Scholar 

  29. D'Agostino MA, Aegerter P, Jousse-Joulin S, Chary-Valckenaere I, Lecoq B, Gaudin P, Brault I, Schmitz J, Dehaut FX, Le Parc JM, Breban M, Landais P (2009) How to evaluate and improve the reliability of power Doppler ultrasonography for assessing enthesitis in spondylarthritis. Arthritis Rheum 61(1):61–69. doi:10.1002/art.24369

    Article  PubMed  Google Scholar 

  30. Ruta S, Gutierrez M, Pena C, Garcia M, Arturi A, Filippucci E, Marcos JC (2011) Prevalence of subclinical enthesopathy in patients with spondyloarthropathy: an ultrasound study. J Clin Rheumatol 17(1):18–22. doi:10.1097/RHU.0b013e318204a6f8

    Article  PubMed  Google Scholar 

  31. Gutierrez M, Di Geso L, Salaffi F, Bertolazzi C, Tardella M, Filosa G, Filippucci E, Grassi W (2012) Development of a preliminary US power Doppler composite score for monitoring treatment in PsA. Rheumatology (Oxford) 51(7):1261–1268. doi:10.1093/rheumatology/kes014

    Article  Google Scholar 

  32. Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, Hartung W, Sattler H, Albrecht K, Kaufmann J, Becker K, Sorensen H, Meier L, Burmester GR, Schmidt WA (2009) Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 61(9):1194–1201. doi:10.1002/art.24646

    Article  CAS  PubMed  Google Scholar 

  33. Naredo E, Rodriguez M, Campos C, Rodriguez-Heredia JM, Medina JA, Giner E, Martinez O, Toyos FJ, Ruiz T, Ros I, Pujol M, Miquel X, Garcia L, Aznar JJ, Chamizo E, Paez M, Morales P, Rueda A, Tuneu R, Corominas H, de Agustin JJ, Moragues C, Minguez D, Willisch A, Gonzalez-Cruz I, Aragon A, Iglesias G, Armas C, Pablo Valdazo J, Vargas C, Calvo-Alen J, Juan-Mas A, Salvador G, Puigdollers A, Galindez E, Garrido N, Salaberri J, Raya E, Salles M, Diaz C, Cuadra JL, Garrido J (2008) Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 59(4):515–522. doi:10.1002/art.23529

    Article  PubMed  Google Scholar 

  34. Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64(3):375–381. doi:10.1136/ard.2004.023929

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Saleem B, Brown AK, Keen H, Nizam S, Freeston J, Wakefield R, Karim Z, Quinn M, Hensor E, Conaghan PG, Emery P (2011) Should imaging be a component of rheumatoid arthritis remission criteria? A comparison between traditional and modified composite remission scores and imaging assessments. Ann Rheum Dis 70(5):792–798. doi:10.1136/ard.2010.134445

    Article  PubMed  Google Scholar 

  36. Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, Hensor E, Wakefield RJ, O'Connor PJ, Emery P (2008) An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 58(10):2958–2967. doi:10.1002/art.23945

    Article  CAS  PubMed  Google Scholar 

  37. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, Wakefield RJ, O'Connor PJ, Emery P (2006) Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 54(12):3761–3773. doi:10.1002/art.22190

    Article  CAS  PubMed  Google Scholar 

  38. Filippucci E, Gabba A, Di Geso L, Girolimetti R, Salaffi F, Grassi W (2012) Hand tendon involvement in rheumatoid arthritis: an ultrasound study. Semin Arthritis Rheum 41(6):752–760. doi:10.1016/j.semarthrit.2011.09.006

    Article  PubMed  Google Scholar 

  39. Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W (2011) Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level. Ann Rheum Dis 70(6):1111–1114. doi:10.1136/ard.2010.147272

    Article  PubMed  Google Scholar 

  40. Wiell C, Szkudlarek M, Hasselquist M, Moller JM, Vestergaard A, Norregaard J, Terslev L, Ostergaard M (2007) Ultrasonography, magnetic resonance imaging, radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis. Arthritis Res Ther 9(6):R119. doi:10.1186/ar2327

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no any potential financial conflict of interest concerning this study.

Funding statement

This work was supported by a grant from AbbVie S.A.

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Authors and Affiliations

  1. Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Santiago Ruta, María Laura Acosta Felquer, Javier Rosa, David A. Navarta & Enrique R. Soriano

  2. Radiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Ricardo García Monaco

  3. Fundacion Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina

    Enrique R. Soriano

  4. University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Santiago Ruta, María Laura Acosta Felquer, Javier Rosa, David A. Navarta & Enrique R. Soriano

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  1. Santiago Ruta
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  2. María Laura Acosta Felquer
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Ruta, S., Acosta Felquer, M.L., Rosa, J. et al. Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients. Clin Rheumatol 34, 125–132 (2015). https://doi.org/10.1007/s10067-014-2673-4

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