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| Poor Agreement Between Enthesitis on Whole-Body Magnetic Resonance Imaging and Enthesitis on Clinical Examination in Patients with Early Axial Spondyloarthritis – Results From the ESTHER Trial At Baseline
In-Ho Song 1, Kay-Geert Hermann2, Hildrun Haibel1, Christian Althoff2, Denis Poddubnyy1, Joachim Listing3, Anja Weiß3, Bruce Freundlich4, Martin Rudwaleit5 and Joachim Sieper1, 1Charité Medical University, Campus Benjamin Franklin, Berlin, Germany, 2Charite Medical School, Berlin, Germany, 3German Rheumatism Research Centre, Berlin, Germany, 4University of Pennsylvania, Philadelphia, PA, 5Ev. Krankenhaus Hagen-Haspe, Hagen, Germany
Presentation Number: 515
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. Method: 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). 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.
| 全身MRI与临床检查在检测早期中轴脊柱关节病患者附着点炎方面一致性差－来自ESTHER临床试验基线水平的数据 In-Ho Song , et al. Present No: 515
背景/目的:评价全身核磁共振(MRI)和临床体检在检测病程< 5年的早期中轴脊柱关节炎 (SpA)患者的附着点炎的一致性 。 方法:在基线水平，通过临床体检和全身MRI检测了76例早期SpA的附着点炎，MRI(M)和临床检查(C)下列7个部位: 胸柄结合(M)/第一肋胸关节 (C)(1个部位), 低位肋骨与胸骨连接部位 (M)/ 第7肋胸关节(C)(2个部位,每个部位左和右)、骨盆环(M)/髂嵴(C)(2个部位,每个左和右),近端跟腱附着处/跖筋膜(M / C)(2个部位,每个左和右)。计算MRI和临床检查结果一致性的Kappa值。由两个放射科医师采用相同方法评估MRI 附着点炎 。 结果:上述部位的检测中，临床检查发现76例患者中40例(60.5%)有附着点炎，共有108个部位。最常见的部位是髂嵴(30例患者45个部位),其次是第7肋胸关节 (16例患者26个部位),跟腱附着处/跖筋膜(14例患者22个部位)和第1肋胸关节 (15例患者15个部位)(表1)。 MRI检查发现76例患者中有6例患者存在附着点炎，共9个部位。最常见胸柄结合处(3名患者3个部位),其次是跟腱附着处(3例患者4个部位)。 76例患者中有67例在BASDAI积分时附着点问题积分 (BASDAI问题4) ≥1 。 MRI和临床检查在检测附着点炎方面的Kappa值仅0.038。单病人水平的Kappa也只有-0.011。临床检查和患者BASDAI问题4的自我评估之间Kappa值为0.1。所有病人中,仅有3个附着点炎的部位在同一时间的MRI和临床检查中有一致性的发现。 结论:在早期中轴SpA患者的上述附着点炎部位，临床及MRI 的检出率分别为 52.6%和7.9% 。两种方法的一致性较差。 | |||||||||||||||||||||||||||||||||||||||||||
| Table 1.
* 1= yes, 0= no. [1] Song I.-H. et al. 2011. Ann Rheum Dis. 2011 Apr;70(4):590-6.
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全身MRI与临床检查在检测早期中轴脊柱关节病患者附着点炎方面一致性差－来自ESTHER临床试验基线水平的...
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