Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Poor Agreement Between Enthesitis on Whole-Body Magnetic Resonance Imaging and Enthesitis on Clinical Examination in Patients with Early Axial SpondyloarthritisResults From the ESTHER Trial At Baseline.

Song¹, In-Ho, Hermann², Kay-Geert, Haibel¹, Hildrun, Althoff², Christian, Poddubnyy¹, Denis, Listing³, Joachim, Weibeta³, Anja

Charité Medical University, Campus Benjamin Franklin, Berlin, Germany
Charite Medical School, Berlin, Germany
German Rheumatism Research Centre, Berlin, Germany
University of Pennsylvania, Philadelphia, PA
Ev. Krankenhaus Hagen-Haspe, Hagen, Germany

Background/Purpose:

In patients with early axial spondyloarthritis (SpA) with a disease duration of < 5 years to assess the agreement between enthesitis on whole-body magnetic resonance imaging (MRI) and enthesitis by clinical examination.

Methods:

At baseline 76 patients with early axial SpA were examined for enthesitis by clinical examination and by whole-body MRI. The following 7 enthesitis sites were assessed by MRI (M) and clinical examination (C): manubriosternal synchondrosis (M)/ first costosternal joint (C) (1 site), lower rip insertions at the sternum (M)/ 7^th costochondral joints (C) (2 sites, each left and right), pelvic rim (M)/ iliac crest (C) (2 sites, each left and right), proximal insertion of Achilles tendon/ plantar fascia (M/C) (2 sites, each left and right). Kappa values were calculated to assess agreement between MRI findings and clinical examination. MRI enthesitis assessment was performed by two radiologists in consensus approach.

Results:

By clinical enthesitis assessment in the above described locations 108 enthesitic sites were found in 40 out of 76 (60.5%) patients. The most frequently affected location was the iliac crest (45 sites in 30 patients) followed by the 7^th costosternal joint (26 sites in 16 patients), the insertion of the Achilles tendon/plantar fascia (22 sites in 14 patients) and the 1^st costosternal joint (15 sites in 15 patients) (table 1).

Table 1.

MRI enthesitis location	Clinical examination enthesitis location	Number of positive enthesitic sites on MRI	Number of positive enthesitic sites on clinical examination	Agreement*
Synchondrosis manubriosternalis	First Costosternal joint	3 sites in 3 patients	15 sites in 15 patients	1
Lower rip insertions at the sternum (Rip)	Seventh Costosternal joint	Right: 0 sites in 0 patients	11 sites in 11 patients	0
		Left: 0 sites in 0 patients	15 sites in patients	0
		Both: 0 sites in 0 patients	26 sites in 16 patients	0
Pelvic rim (Bec)	Crista iliaca/ Spina iliaca anterior superior/Spina iliaca posterior superior	Right: 1 site in 1 patient	23 sites in 23 patients	1
		Left: 1 site in 1 patient	22 sites in 22 pts	0
		Both: 2 sites in 1 patient	45 sites in 30 patients	1
Achilles tendon insertion (Ach)	Prox. Achilles tendon insertion	Right: 2 sites in 2 patients	9 sites in 9 pts	0
		Left: 2 sites in 2 patients	13 sites in 13 pts	1
		Both: 4 sites in 3 patient	22 sites in 14 patients	1
* 1= yes, 0= no.

Of MRI examination in the above described locations 9 enthesitic sites were found in 6 out of the 76 patients. The most frequently affected sites were the manubriosternal synchondrosis (3 sites in 3 patients), followed by the Achilles tendon insertion (4 sites in 3 patients).

67 out of 76 patients scored the enthesitis question (BASDAI question 4) of the BASDAI >=1.

The kappa values in terms of single enthesitic sites between MRI and clinical examination was only 0.038. The kappa value on a patient level was also only -0.011. Kappa between clinical examination and self-assessment by BASDAI question 4 was 0.1. In all patients enthesitic only 3 enthesitic sites were found to be positive in both by MRI and clinical examination at the same time.

Conclusion:

Clinical and MRI enthesitis was found in 52.6% and 7.9% of patients in the above mentioned enthesitis sites with early axial SpA, respectively. The agreement between clinical and MRI enthesitis assessment was poor.

[1]Song, I.-H. et al. 2011. Ann Rheum Dis. 2011 Apr;70(4):590–6.

To cite this abstract, please use the following information:
Song, In-Ho, Hermann, Kay-Geert, Haibel, Hildrun, Althoff, Christian, Poddubnyy, Denis, Listing, Joachim, et al; Poor Agreement Between Enthesitis on Whole-Body Magnetic Resonance Imaging and Enthesitis on Clinical Examination in Patients with Early Axial SpondyloarthritisResults From the ESTHER Trial At Baseline. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :515
DOI:

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