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)/ 7th 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 7th costosternal joint (26 sites in 16 patients), the insertion of the Achilles tendon/plantar fascia (22 sites in 14 patients) and the 1st costosternal joint (15 sites in 15 patients) (table 1).

Table 1.

MRI enthesitis locationClinical examination enthesitis locationNumber of positive enthesitic sites on MRINumber of positive enthesitic sites on clinical examinationAgreement*
Synchondrosis manubriosternalisFirst Costosternal joint3 sites in 3 patients15 sites in 15 patients1
Lower rip insertions at the sternum (Rip)Seventh Costosternal jointRight: 0 sites in 0 patients11 sites in 11 patients0
  Left: 0 sites in 0 patients15 sites in patients0
  Both: 0 sites in 0 patients26 sites in 16 patients0
Pelvic rim (Bec)Crista iliaca/ Spina iliaca anterior superior/Spina iliaca posterior superiorRight: 1 site in 1 patient23 sites in 23 patients1
  Left: 1 site in 1 patient22 sites in 22 pts0
  Both: 2 sites in 1 patient45 sites in 30 patients1
Achilles tendon insertion (Ach)Prox. Achilles tendon insertionRight: 2 sites in 2 patients9 sites in 9 pts0
  Left: 2 sites in 2 patients13 sites in 13 pts1
  Both: 4 sites in 3 patient22 sites in 14 patients1
* 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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