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.


Radiological Characteristics of the Calcaneal Spurs in Psoriatic Arthritis.

Abufayyah1,  Mohammed, Salonen2,  David, Thavaneswaran3,  Arane, Chandran1,  Vinod, Gladman3,  Dafna D.

Toronto Western Hospital and University of Toronto, Toronto, ON
University Health Network, Toronto, ON
Toronto Western Hospital, University of Toronto, Toronto, ON

Background/Purpose:

Inflammation at the entheses is a distinguishing feature of psoriatic arthritis (PsA). Enthesitis at the heel is the most common location; irregular spiculated calcifications often at sites of enthesis such as the Achilles and plantar fascia insertions on the calcaneous. This study aimed to 1) describe the morphological features and measurements of plantar calcaneal spurs on weight bearing lateral foot radiographs in subjects with PsA and controls and 2) determine radiological features that differentiate between inflammatory & non-inflammatory calcaneal spurs.

Methods:

Weight bearing lateral foot radiographs of 101 subjects with PsA and 38 control subjects without inflammatory arthritis were examined for plantar calcaneal and Achilles spurs. Three measurements were taken from each radiograph: plantar spur base, mid-segment, and length in millimeters as shown in Figure 1. The differences in radiographic measurements, and the presence of fluffy periostitis of the plantar spurs were then compared between PsA patients and controls.

Results:

Of the 101 subjects with PsA, 76 (75%) had at least one plantar calcaneal spur and 32 (31.5%) had at least one Achilles tendon spur, compared to 18 (47%) and 3 (8%) respectively in control group (p=0.004). The presence of fluffy plantar periostitis was identified in 14 PsA subjects but in none of the controls (p=0.01). The dimensions of plantar spurs were significantly different between groups (table 1); Logistic regression identified that gender and mid-segment distinguished patients with PsA from controls.

Table 1. Demographics, Radiological characteristics and Measurement of Calcaneal Spurs:

VariableMean (stdev) or Frequency (%)p-value
PsAControls 
n=101n=38 
Gender (M/ F)65 (64.4%)/36 (35.6%)15 (39.5%)/23 (60.5%)0.008
Age41.1 (10.8)49.2 (14.7)0.003
Obesity42 (44.7%)6 (46.1%)0.92
DISH4 (4.0%)0 (0.0%)0.21
Achilles Spurs32 (31.5%)3 (8%)0.004
Plantar Spurs76 (75.0%)18 (47.5%)0.002
Bilateral5611 
Unilateral207 
Fluffy plantar periostitis14 (8.4%)0 (0.0%_)0.01
Base (mm)7.1 (2.8)4.6 (1.5)<0.0001
Mid (mm)4.9 (2.2)2.3 (0.9)<0.0001
Length (mm)4.5 (2.1)4.2 (1.7)0.57

Figure 1. Lateral radiograph with measured dimensions of plantar spur; (A) Spur base; (B) Mid-segment; and (C) Spur length.

Conclusion:

In this observational study we found that calcaneal spurs are more common in subjects with PsA, and that a higher midsegment measurement was associated with PsA. This study provides radiological differentiating features between inflammatory and non-inflammatory spurs including the presence of fluffy plantar periostitis and broad based and mid-segment dimensions.

To cite this abstract, please use the following information:
Abufayyah, Mohammed, Salonen, David, Thavaneswaran, Arane, Chandran, Vinod, Gladman, Dafna D.; Radiological Characteristics of the Calcaneal Spurs in Psoriatic Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :549
DOI:

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