Asunto(s)
Artritis Psoriásica/diagnóstico por imagen , Articulación Atlantoaxoidea/diagnóstico por imagen , Imagenología Tridimensional , Luxaciones Articulares/diagnóstico por imagen , Espondiloartritis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Artritis Psoriásica/complicaciones , Articulación Atlantoaxoidea/fisiopatología , Humanos , Luxaciones Articulares/etiología , Masculino , Dolor de Cuello/diagnóstico , Dolor de Cuello/etiología , Enfermedades Raras , Espondiloartritis/complicacionesAsunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Aortitis/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Policondritis Recurrente/tratamiento farmacológico , Adulto , Aortitis/diagnóstico , Aortitis/inmunología , Humanos , Masculino , Policondritis Recurrente/complicaciones , Policondritis Recurrente/diagnóstico , Policondritis Recurrente/inmunología , Inducción de Remisión , Resultado del TratamientoRESUMEN
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Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/diagnóstico , Calcinosis/complicaciones , Calcinosis/patología , Nifedipino/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Calcinosis , Vértebras Cervicales/patología , Vértebras Cervicales , Tomografía/métodos , TomografíaRESUMEN
OBJECTIVE: To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA). METHODS: A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A PDUS examination of 14 peripheral entheses was performed by the same investigator in each center at baseline and at 6 months. The following elementary lesions were assessed at each enthesis (presence/absence): morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. Response to therapy of each elementary lesion was assessed by calculating change in the cumulative presence from baseline to 6 months. Intraobserver reliability of PDUS was evaluated by blindly assessing the stored baseline images 3 months after the real-time examination. RESULTS: Complete data were obtained on 197 patients who received anti-TNF therapy for 6 months. In 91.4% of the patients there were gray-scale or PD elementary lesions at baseline and at 6 months. Cumulative entheseal morphologic abnormalities, intraenthesis PD, perienthesis PD, and bursitis showed a significant decrease from baseline to 6 months (p < 0.05). There was high intraobserver reliability for all elementary lesions (interclass correlation coefficient > 0.90, p < 0.0005). CONCLUSION: Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.
Asunto(s)
Espondiloartropatías/diagnóstico por imagen , Espondiloartropatías/patología , Tendinopatía/diagnóstico por imagen , Tendinopatía/patología , Tendones , Ultrasonografía Doppler/métodos , Adulto , Bursitis/diagnóstico por imagen , Bursitis/tratamiento farmacológico , Bursitis/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , España , Espondiloartropatías/tratamiento farmacológico , Tendinopatía/tratamiento farmacológico , Tendones/anomalías , Tendones/diagnóstico por imagen , Tendones/patología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
OBJECTIVE: To investigate the validity, reproducibility, and responsiveness of a simplified power Doppler ultrasound (PDUS) assessment of joint inflammation compared with a comprehensive 44-joint PDUS assessment in patients with rheumatoid arthritis (RA) who started therapy with a biologic agent. METHODS: A total of 160 patients with active RA who started a biologic agent were prospectively recruited in 18 Spanish centers. The patients underwent clinical and laboratory assessment and blinded PDUS examination at baseline and 6 months. A PDUS examination of 128 synovial sites in 44 joints was performed. US synovitis and PD signal were semiquantitatively graded from 1 to 3 in all synovial sites. US count and index for synovitis and PD signal were obtained. PDUS intraobserver and interobserver reliability were evaluated. A process of data reduction based on the frequency of involvement of synovial sites by both synovitis and PD signal was conducted. Construct and discriminant validity of a simplified PDUS assessment was investigated. RESULTS: A PDUS simplified assessment including 24 synovial sites from 12 joints detected 100% of patients with synovitis and 91% of patients with PD signal. There was a highly significant correlation between the 44-joint count and index for synovitis and PD signal and the 12-joint count and index for synovitis and PD signal at baseline and 6 months (r = 0.84-0.90, P < 0.0005). The smallest detectable difference was lower than the mean change in simplified PDUS variables. CONCLUSION: A 12-joint PDUS assessment of RA joint inflammation may be a valid, feasible method for multicenter monitoring of therapeutic response to biologic agents.