Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy
Objectives: To investigate the anatomical distribution, morphological abnormalities and response to adalimumab therapy of ultrasound(US)-detected peripheral enthesitis in patients with axial spondyloarthritis (SpA).Methods: In a randomized, placebo-controlled, double-blinded, investigator-initiated...
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Frontiers Media S.A.
2020-07-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.00341/full |
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| author | Sengul Seven Sengul Seven Susanne Juhl Pedersen Susanne Juhl Pedersen Mikkel Østergaard Mikkel Østergaard Sara Kamp Felbo Sara Kamp Felbo Inge Juul Sørensen Uffe Møller Døhn Lene Terslev Lene Terslev |
| author_facet | Sengul Seven Sengul Seven Susanne Juhl Pedersen Susanne Juhl Pedersen Mikkel Østergaard Mikkel Østergaard Sara Kamp Felbo Sara Kamp Felbo Inge Juul Sørensen Uffe Møller Døhn Lene Terslev Lene Terslev |
| author_sort | Sengul Seven |
| collection | DOAJ |
| description | Objectives: To investigate the anatomical distribution, morphological abnormalities and response to adalimumab therapy of ultrasound(US)-detected peripheral enthesitis in patients with axial spondyloarthritis (SpA).Methods: In a randomized, placebo-controlled, double-blinded, investigator-initiated trial (NCT01029847), patients with axial SpA according to the Assessment of Spondyloarthritis International Society criteria were randomized to subcutaneous adalimumab 40 mg every other week or placebo from baseline to week 6. From week 6 to 24, all patients received adalimumab 40 mg every other week. Of 49 patients enrolled, 21 patients participated in our observational US sub-study. US assessment applying the OMERACT US definitions for enthesitis of 10 peripheral entheseal regions of the upper and lower extremities and clinical examination were performed at baseline, weeks 6 and 24. US was performed by one experienced investigator. Hypo-echogenicity, increased thickness and Doppler activity of the enthesis were considered signs of active inflammation, whereas insertional bone erosions, intratendinous calcifications, and enthesophytes were regarded as signs of structural lesions.Results: Enthesitis on US was mostly present in the lower limbs, especially in the Achilles tendon (81%), the quadriceps tendon (62%), and the greater femoral trochanter (52%). Structural lesions were predominant (38 vs. 12% of examined entheses with inflammatory changes), particularly in the entheses of the lower limbs, and exhibited no change during treatment.Conclusion: US-detected structural lesions were common while inflammatory lesions were relatively rare in patients initiating adalimumab due to axial SpA. Structural lesions did not appear to change during 24 weeks follow-up, suggesting that these lesions may not be helpful outcome measures in short-term clinical trials. |
| first_indexed | 2024-12-14T11:36:19Z |
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| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-14T11:36:19Z |
| publishDate | 2020-07-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-4f2595bda2934ec7ad6a7da63d13ae162022-12-21T23:03:02ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-07-01710.3389/fmed.2020.00341545048Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor TherapySengul Seven0Sengul Seven1Susanne Juhl Pedersen2Susanne Juhl Pedersen3Mikkel Østergaard4Mikkel Østergaard5Sara Kamp Felbo6Sara Kamp Felbo7Inge Juul Sørensen8Uffe Møller Døhn9Lene Terslev10Lene Terslev11Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCopenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCopenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCopenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkCopenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkCopenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkCopenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, DenmarkDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, DenmarkObjectives: To investigate the anatomical distribution, morphological abnormalities and response to adalimumab therapy of ultrasound(US)-detected peripheral enthesitis in patients with axial spondyloarthritis (SpA).Methods: In a randomized, placebo-controlled, double-blinded, investigator-initiated trial (NCT01029847), patients with axial SpA according to the Assessment of Spondyloarthritis International Society criteria were randomized to subcutaneous adalimumab 40 mg every other week or placebo from baseline to week 6. From week 6 to 24, all patients received adalimumab 40 mg every other week. Of 49 patients enrolled, 21 patients participated in our observational US sub-study. US assessment applying the OMERACT US definitions for enthesitis of 10 peripheral entheseal regions of the upper and lower extremities and clinical examination were performed at baseline, weeks 6 and 24. US was performed by one experienced investigator. Hypo-echogenicity, increased thickness and Doppler activity of the enthesis were considered signs of active inflammation, whereas insertional bone erosions, intratendinous calcifications, and enthesophytes were regarded as signs of structural lesions.Results: Enthesitis on US was mostly present in the lower limbs, especially in the Achilles tendon (81%), the quadriceps tendon (62%), and the greater femoral trochanter (52%). Structural lesions were predominant (38 vs. 12% of examined entheses with inflammatory changes), particularly in the entheses of the lower limbs, and exhibited no change during treatment.Conclusion: US-detected structural lesions were common while inflammatory lesions were relatively rare in patients initiating adalimumab due to axial SpA. Structural lesions did not appear to change during 24 weeks follow-up, suggesting that these lesions may not be helpful outcome measures in short-term clinical trials.https://www.frontiersin.org/article/10.3389/fmed.2020.00341/fullimagingultrasoundenthesitisspondyloarthritisinflammation |
| spellingShingle | Sengul Seven Sengul Seven Susanne Juhl Pedersen Susanne Juhl Pedersen Mikkel Østergaard Mikkel Østergaard Sara Kamp Felbo Sara Kamp Felbo Inge Juul Sørensen Uffe Møller Døhn Lene Terslev Lene Terslev Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy Frontiers in Medicine imaging ultrasound enthesitis spondyloarthritis inflammation |
| title | Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy |
| title_full | Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy |
| title_fullStr | Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy |
| title_full_unstemmed | Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy |
| title_short | Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis—Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy |
| title_sort | peripheral enthesitis detected by ultrasonography in patients with axial spondyloarthritis anatomical distribution morphology and response to tumor necrosis factor inhibitor therapy |
| topic | imaging ultrasound enthesitis spondyloarthritis inflammation |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.00341/full |
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