AB1161 ULTRASOUND IMAGING IN EVALUATION OF ENTHESITIS: STATUS AND PERSPECTIVES
Authors: José Alexandre MendonÇa, Lana Bezerra Fernandes, Waldemar Naves Do Amaral
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The high-frequency ultrasound is a reliable method to identify enthesitis, including subclinical and early diagnosis, in patients with psoriasis (Pso) and psoriatic arthritis (PsA)<sup>1</sup>. <h3>Objectives</h3> To establish an epidemiological profile of patients with Pso and/or subclinical and clinical PsA; to establish the ultrasound (US) profile with gray scale and Doppler in entheses in these groups. <h3>Methods</h3> A case control study conducted in the period from December 2015 to December 2016, at Hospital das Clínicas/UFG. It was performed in 144 patients with Pso and/or PsA and 24 healthy controls. Patients with and without arthritis/enthesitis were submitted to the US. The US findings were according to the MASEI (the Madrid sonography enthesitis index). The entheses were studied bilaterally: plantar fascia, distal calcaneal tendon, distal and proximal ligament of the patella, distal quadriceps and tendons of the brachial triceps. In addition to the US in the 2nd and 3rd distal interfalanges. The interobserver reliability was calculated in 24 patients - kappa index (k). <h3>Results</h3> In the case group the mean age was 50.13 years, BMI of 28.14; duration of illness of 16 years; <b>Mean±SD PASI: 5.34±6,03; PEST:2,21±1,66 and DLQI:4.39±5,16</b>. Of the total 90.3% of the patients presented Pso; 39.8% APs already diagnosed and 77.8% with signs of US enthesopathy. Of the total of the 1728 entheses evaluated in the case group and the control group of 288 structures evaluated. The most common sign in both groups was the thickening, being more seen in the calcaneus tendon (table). The MASEI score was significantly higher in patients with Pso and PsA than in the control group and had correlation with <b>PEST: r= 0,397, p&lt;0,001 and IMC: r=0,208, p= 0,012</b>. Of the 288 nail insertion of the 2nd and 3rd distal interphalangeal, presented some type of enthesopathy to the US, like thickening <b>(34,7%, p=0,036 to 0,003)</b> or loss of the trilaminar pattern <b>(31,6%, p= 0,027 to 0,004)</b> and the most common change was positive PD <b>(61,1%, p&lt;0,001)</b>. Of the total nails evaluated only 17.5% had clinic injury. And the κ values weighted for the US findings showed excellent agreement <b>(0.930 and 1)</b> for PD and erosions, respectively. The epidemiological profile of patients with Pso and/or subclinical and clinical PsA were overweight. As for the US profile, the majority presented signs of enthesopathy, where the most frequent occurrence was the calcaneal tendon, and the Doppler was the most affected topography of the triceps tendon. <h3>Conclusion</h3> The ultrasonography shows an important perspective in assessing entheses these patients. <h3>References</h3> [1] Kaeley, G. S., Eder, L., Aydin, S. Z., Gutierrez, M., &amp; Bakewell, C. Enthesitis: A hallmark of psoriatic arthritis. Seminars in Arthritis and Rheumatism., 2018; 48(1), 35–43. Test: Chi-Square; (PD: power Doppler). <h3>Disclosure of Interests</h3> None declared