The Association of Achilles Sonoelastography Findings with Disease Activity, Functional Status and Enthesitis Index in Patients with Axial Spondyloarthritis

Abstract

Background Sonoelastography (SE) is a new ultrasound (US)-based technique able to assess tissue elasticity. Using conventional US, it is sometimes difficult or even impossible to distinguish pathologic tissue because it often presents with the same echogenicity as the surrounding healthy tissue. This study aimed to evaluate SE findings in Achilles tendons of patients with axial spondyloarthritis (axSpA) and to assess how these findings are associated with disease-related parameters.

Material and Methods Sixty-four consecutive patients (37 men, 27 women; mean age 39.7 years; range 20–65 years) with axSpA and 30 sex and age-matched healthy controls were enrolled in the study. Disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), whereas functional capacity was evaluated using the Bath Ankylosing Spondylitis Functional Index (BASFI). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index were recorded. All participants underwent an SE examination of the Achilles tendon and measurement of the strain index (SI).

Results The mean right and left SI were significantly higher in axSpA patients than in controls (2.96±0.94 vs. 1.90±0.45; p<0.001; 2.95±0.95 vs. 1.92±0.48, p<0.001, respectively). In axSpA patients, both right and left SI were significantly correlated with the BASDAI, BASFI and SPARCC enthesitis indices, but not with ESR or CRP.

Conclusion AxSpA patients had an increased SI compared with healthy subjects and these values were associated with disease activity, functional capacity and the enthesitis index. SE may be a useful tool for the evaluation of Achilles tendons in patients with axSpA.

Zusammenfassung

Hintergrund Die Sonoelastographie (SE) ist ein neuer Ultraschall (US)-basiertes Verfahren zur Beurteilung der Gewebeelastizität. Mit konventionellem US ist es manchmal schwierig oder sogar unmöglich, pathologisches Gewebe zu unterscheiden, da es oft die gleiche Echogenität aufweist wie das umgebende gesunde Gewebe. Das Ziel dieser Studie war es, diese Befunde der Achillessehne bei axialer Spondyloarthritis (ax-SpA) zu bewerten und ihren Zusammenhang mit krankheitsbezogenen Parametern zu beurteilen.

Material und Methoden 64 aufeinanderfolgende Patienten (37 Männer, 27 Frauen; Durchschnittsalter 39,7 Jahre; Bereich 20–65 Jahre) mit ax-SpA und 30 geschlechts- und altersgleichen gesunden Kontrollpersonen wurden in die Studie aufgenommen. Die Krankheitsaktivität wurde unter Verwendung des Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) bewertet, während die funktionelle Kapazität unter Verwendung des Bath Ankylosing Spondylitis Functional Index (BASFI) bewertet wurde. Erythrozytensedimentationsrate (ESR), C-reaktives Protein (CRP), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis-Index wurden aufgezeichnet. Bei allen Teilnehmern wurde eine SE-Untersuchung der Achillessehne durchgeführt und der Strain index (SI) gemessen.

Ergebnisse Der mittlere rechte und linke SI war bei ax-SpA Patienten signifikant höher als bei den Kontrollen (2,96±0,94 vs 1,90±0,45, P ˂0,001; 2,95±0,95 vs 1,92±0,48, P ˂ 0,001, jeweils). Bei ax-SpA Patienten waren sowohl die rechte als auch die linke SI signifikant mit dem BASDAI, dem BASFI und dem SPARCC-Enthesitis-Index korreliert, nicht aber mit ESR oder CRP.

Schlussfolgerung Ax-SpA-Patienten hatten im Vergleich zu gesunden Probanden einen erhöhten SI und diese Werte waren mit Krankheitsaktivität, funktioneller Kapazität und Enthesitis-Index assoziiert. SE kann ein nützliches Hilfsmittel für die Bewertung der Achillessehne bei ax-SpA sein.

Key words

Achilles tendon - axial spondyloarthritis - sonoelastography - strain index

Schlüsselwörter

Axiale Spondyloarthritis - Achillessehne - Sonoelastographie - Strain index

Publikationsverlauf

Artikel online veröffentlicht:
16. März 2022

• References

• 1 Terenzi R, Monti S, Tesei G. et al. One year in review 2017: spondyloarthritis. Clin Exp Rheumatol 2018; 36: 1-14
• 2 Gandjbakhch F, Tersley L, Joshua F. et al. Ultrasound in the evaluation of enthesitis: status and perspectives. Arthritis Res Ther 2011; 13: R188
• 3 Eder L, Barzilai M, Peled N. et al. The use of ultrasound for the assesment of enthesitis in patients with spondyloarthritis. Clin Radiol 2013; 68: 219-223
• 4 D'Agostino MA. Role of ultrasound in the diagnostic work-up of spondyloarthritis. Curr Opin Rheumatol 2012; 24: 375-379
• 5 Klauser AS, Miyamoto H, Bellman-Weiler R. et al. Sonoelastography: Musculoskeletal Applications. Radiology 2014; 271: 622-633
• 6 Wu CH, Chen WS, Park GY. et al. Musculoskeletal Sonoelastography: A Focused Review of its Diagnostic Applications for Evaluating Tendons and Fascia. J Med Ultrasound 2012; 20: 79-86
• 7 Ooi CC, Malliaras P, Schneider ME. et al. “Soft, hard, or just right?”Application and limitations of axial-strain sonoelastography and shear-wave elastography in the assesment of tendon injuries. Skeletal Radio 2014; l43: 1-12
• 8 Winn N, Lalam R, Cassar-Pullicino V. Sonoelastography in the musculoskeletal system: Current role and future directions. World J Radiol 2016; 8: 868-879
• 9 Galletti S, Oliva F, Masiero S. et al. Sonoelastography in the diagnosis of tendinopathies: an added value. Muscles Ligaments Tendons J 2016; 5: 325-330
• 10 Turan A, Tufan A, Mercan R. et al. Real-time sonoelastography of Achilles tendon in patients with anklosing spondylitis. Skeletal Radiol 2013; 2: 1113-1118
• 11 Rudwaleit M, van der Heijde D, Landewe R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-783
• 12 Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27: 361-368
• 13 Garrett S, Jenkinson T, Kennedy LG. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-2291
• 14 Calin A, Garrett S, Whitelock H. et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994; 21: 2281-2285
• 15 Maksymowych WP, Mallon C, Morrow S. et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Ann Rheum Dis 2009; 68: 9489-9453
• 16 D’Agostino MA, Aegerter P, Bechara K. et al. How to diagnose spondyloarthritis early? Accuracy of peripheral enthesitis detection by power Doppler ultrasonography. Ann Rheum Dis 2011; 70: 1433-1440
• 17 Mata Arnaiz MC, de Miguel Mendieta E. Usefulness of ultrasonography in the assesment of peripheral enthesis in spondyloarthritis. Rheumatol Clin 2014; 10: 113-119
• 18 Eshed I, Hermann KG. Novel imaging modalities in spondyloarthritis. Curr Opin Rheumatol 2015; 7: 333-342
• 19 OOi CC, Schneider ME, Malliaras P. et al. Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging. Ultrasound Med Biol 2015; 41: 15-25
• 20 Kim MY, Cho N, Yi A. et al. Sonoelastography in distinguishing benign from malignant complex breast mass and making the decision to biopsy. Korean J Radiol 2013; 14: 559-567
• 21 Bojunga J, Herrmann E, Meyer G. et al. Real-time elastography for the differentation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 2010; 20: 1145-1150
• 22 Good DW, Stewart GD, Hammer S. et al. Elasticity as a biomarker for prostate cancer: a systemic review. BJU Int 2014; 113: 523-534
• 23 Lenghel LM, Botar Jid C, Bolboaca SD. et al. Comparative study of three sonoelastographic scores for differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 2015; 84: 1075-1082
• 24 Yuan S, Magarik M, Lex AM. et al. Clinical applications of sonoelastography. Expert Rev Med Devices 2016; 13: 1107-1117
• 25 De Zordo T, Fink C, Feuchtner GM. et al. Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol 2009; 193: W134-W138
• 26 Frey H. Realtime elastography: A new ultrasound procedure for the reconstruction of tissue elasticity. Radiologe 2003; 43: 850-855
• 27 Klauser AS, Miyamoto H, Tamegger M. et al. Achilles tendon assessed with sonoelastography: histologic agrement. Radiolgy 2013; 267: 837-842
• 28 Drakonaki EE, Allen GM, Wilson DJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol 2009; 64: 1196-1202
• 29 Spoorenberg A, van Tubergen A, Landewé R. et al. Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology (Oxford) 2005; 44: 789-795
• 30 Zardi EM, Pipita ME, Giorgi C. et al. Strain Ultrasound Elastography in the Achilles Tendon of Ankylosing Spondylitis Patients Treated With Anti-TNF-α: A Preliminary Study. In Vivo 2019; 33: 1635-1640