AB1311 Ultrasound evaluation of enthesis in psoriatic arthritis: a systematic literature review
Authors: I. Janta, T. Gudu, R. Ionescu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Enthesis involvement is considered as a key pathological lesion in psoriatic arthritis (PsA) patients. Recently, ultrasound (US) became an important tool to evaluate the enthesis involvement in PsA. Power Doppler (PD) is able to identify vascular abnormalities which are known to be associated with inflammation. <h3>Objectives</h3> To perform a systematic literature review on how enthesis are evaluated by US in PsA. <h3>Methods</h3> The objective was reformulated according to the PICO approach. Several synonyms for the main components (i.e. ultrasound and enthesis) were used. No search limits were applied. The literature search was performed in Medline and Embase from databases inception to 1st October 2017. References identified were imported into a bibliographic manager. Firstly, duplicates were removed. Then, to identify eligible studies the remaining articles were assessed by title and abstract. Only articles in English and Latin languages were retained. From the selected studies, data about the examined structures, pathological findings and definition used to identify pathology were retired using a predefined data collection form. <h3>Results</h3> The literature search resulted in 411 articles, of which 101 were captured in Medline and 310 in Embase. Figure 1 shows the study flow-chart for article selection. After removing duplicates and scanning titles and abstracts, 41 articles remained for the detailed review. After full-text review, 12 articles were excluded. The main reason for article exclusion after full-text review was the lack of explanation of US evaluation. 29 articles were included in qualitative analysis. The mean (range; SD) number of patients evaluated was 66.3 (7–141; 41.9). The US was used for diagnostic in 26 (89.7%) articles and for monitoring in 7 (24.1%) articles. 4 (13.8%) evaluated also the US nail involvement. All articles used B mode evaluation and 26 (89.7%) used also Doppler mode, all of them using PD. Thickening was evaluated in 27 (93.1%) articles, hypoechogenicity in 21 (72.4%), the presence of enthesophytes in 21 (72.4%) articles, the presence of calcifications in 11 (37.9%) articles, the presence of erosions in 21 (72.4%) articles, irregularities in 8 (27.6%) articles and bursitis in 15 (51.7%) articles, peri-entheseal soft-tissue oedema in 2 articles. Triceps was evaluated in 8 (29.6%) articles, elbow extensors in 8 (29.6%) articles, quadriceps in 14 (51.9%) articles, proximal patellar in 12 (51.9%), distal patellar in 15 (55.6%), Achilles in 22 (81.5%), plantar fascia in 18 (66.7%) and finger extensor in 2 (7.4%), elbow flexors 3, medial collateral ligament in femur condyle 3, supraspinatus tendon in 1 articles, gluteus tendons in 1 article, first and seventh costo-sternal joints, anterior superior iliac spine, and iliac crest, the posterior superior iliac spine, and the fifth lumbar spinous process, rotator cuff in one article. OMERACT definitions were used in 6 (20.6%) articles. Qualitative evaluation was used in 12 (41.3%) articles, semi-quantitative evaluation in 4 (13.7%) articles. As global score, GUESS score was used in 5 (17.2%) articles and MASEI score was used in 4 (13.7%) articles. <h3>Conclusions</h3> Although the majority of the articles evaluated the same enthesis and the same US findings, we found a lack of consensus regarding the global score. <h3>Disclosure of Interest</h3> None declared