Enthesitis Scoring in Spondyloarthritis May Not Reflect Quality of Life

Enthesitis of the heel
Enthesitis of the heel
Researchers compared the clinical Maastricht Ankylosing Spondylitis Enthesitis Score and an established ultrasound enthesitis score after patients with spondyloarthritis and enthesitis changed treatment.

Study data published in Open Access Rheumatology indicate that although the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) may be an effective measure of treatment response in patients with spondyloarthritis, clinical improvement in enthesitis does not correlate with patient-reported quality of life (QoL) outcomes.

Patients with active ankylosing spondylitis (n=65) and psoriatic arthritis without (n=66) or with (n=14) axial involvement undergoing treatment intensification were selected for inclusion in the study. At baseline and after 3 and 6 months of treatment, 13 enthesis sites were scored according to the MASES. Ultrasonography by power Doppler ultrasound was performed on 14 additional entheses. The ultrasonography scoring method shared only the Achilles tendon site with the MASES. Clinical and laboratory parameters were collected at baseline and follow-up visits, including disease severity measures and QoL assessments.

Over 6 months of follow-up, the MASES reduced from 5.57 to 3.12 (P <.001). In a similar fashion, the Doppler sum score decreased from 5.47 to 2.88 (both P <.001). Both MASES and power Doppler ultrasound displayed high sensitivity to change at the 3-month follow-up visit. Specifically, patients initiating anti-tumor necrosis factor experienced a −0.96 and −0.74 mean reduction in MASES and power Doppler ultrasound, respectively, at 3 months follow-up. Patients experienced a significant improvement in all clinical, functional, and health-related QoL scores at the 3- and 6-month follow-up visits. Laboratory parameters also improved at follow-up visits; however, the MASES and power Doppler sum scores were poorly correlated with patient-reported outcomes during follow-up (each Pearson’s r <0.5). In addition, the Doppler sum score was poorly correlated with clinical parameters at baseline, including disease severity, disease duration, and body mass index. Thus, although such measures display sensitivity to enthesitis improvement, MASES and Doppler sum score may not be predictive of patient-reported outcomes.

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These data suggest that MASES is sensitive to treatment response in patients with spondyloarthritis, although score reductions do not appear to correlate with patient-reported QoL. As enthesitis improvements did not appear to directly influence patient-reported outcome measures, investigators suggested the development of an outcome measure for enthesitis alone.

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Hartung W, Nigg A Strunk J, Wolff B. Clinical assessment and ultrasonography in the follow-up of enthesitis in patients with spondyloarthritis: a multicenter ultrasound study in daily clinical practice [published online December 3, 2018]. Open Access Rheumatol. doi: 10.2147/OARRR.S179472