The burden of entheseal changes on ultrasound was significantly higher in patients with systemic lupus erythematosus (SLE) compared with healthy controls, particularly with respect to active inflammation, suggesting that enthesis is a target that should be considered in the assessment of SLE, according to the results of a recent cohort study published in Rheumatology.

As the primary objective of the study, the researchers sought to explore the prevalence and distribution of entheseal ultrasound changes in patients with SLE compared with patients in a control group that included patients with psoriatic arthritis (PsA) and healthy individuals. The secondary objective was to investigate the link between the ultrasound findings and the serologic and clinical data in patients with SLE.

Ultrasound and clinical assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses were conducted by independent rheumatologists in 65 patients with SLE, 50 patients with PsA, and 50 healthy participants. Ultrasound findings were based on Outcome Measures in Rheumatology (OMERACT) definitions. Associations between ultrasound changes and clinical and laboratory findings were evaluated among patients with SLE.


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Ultrasound study detected ≥1 abnormality in ≥1 enthesis in 67.7% of patients with SLE, in 94.0% of participants with PsA, and in 44.0% of healthy controls. Ultrasound findings indicative of active inflammation were reported significantly more often among patients with SLE compared with healthy participants (P <.001). Results showed that the distal enthesis of the patellar tendon was the most frequently involved.

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The presence of a power Doppler signal at the enthesis was shown to be an independent significant predictor of SLE disease activity (SLE Disease Activity Index 2000, P <.001).

The investigators concluded that the burden of entheseal ultrasound changes was significantly higher among patients with SLE compared with healthy controls, particularly with respect to inflammation. With ultrasound playing a role in the evaluation of both clinical and subclinical enthesitis in individuals with SLE, entheseal power Doppler might represent a potential biomarker of SLE disease activity.

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Reference

Di Matteo A, Filippucci E, Cipolletta E, et al. Entheseal involvement in patients with systemic lupus erythematosus: an ultrasound study [published online July 3, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key189