Original

The Journal of the Korean Rheumatism Association 2005; 12(2): 97-107

Published online June 30, 2005

© Korean College of Rheumatology

혈청음성 척추관절병증 환자의 발꿈치뼈 부착부병증에 대한 초음파 검사의 유용성

김해림*·홍지현·윤종현·이상헌*·박성환·김호연

가톨릭대학교 의과대학 내과학교실, 건국대학교 의과대학 내과학교실*

Ultrasonographic Assessment of Calcaneal Enthesopathies in Seronegative Spondyloarthropathies

Hae-Rim Kim, M.D.*, Ji-Hyun Hong, M.D., Chong-Hyeon Yoon, M.D., Sang-Heon Lee, M.D.*, Sung-Hwan Park, M.D., Ho-Youn Kim, M.D.

Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Department of Internal Medicine, Konkuk University School of Medicine*

Correspondence to : Sung-Hwan Park

Abstract

Objective: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). Methods: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. Results: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. Conclusion: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.

Keywords Enthesopathy, Achilles tendinitis, Seronegative spondyloarthropathy, Ultrasonography

Article

Original

The Journal of the Korean Rheumatism Association 2005; 12(2): 97-107

Published online June 30, 2005

Copyright © Korean College of Rheumatology.

혈청음성 척추관절병증 환자의 발꿈치뼈 부착부병증에 대한 초음파 검사의 유용성

김해림*·홍지현·윤종현·이상헌*·박성환·김호연

가톨릭대학교 의과대학 내과학교실, 건국대학교 의과대학 내과학교실*

Ultrasonographic Assessment of Calcaneal Enthesopathies in Seronegative Spondyloarthropathies

Hae-Rim Kim, M.D.*, Ji-Hyun Hong, M.D., Chong-Hyeon Yoon, M.D., Sang-Heon Lee, M.D.*, Sung-Hwan Park, M.D., Ho-Youn Kim, M.D.

Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Department of Internal Medicine, Konkuk University School of Medicine*

Correspondence to:Sung-Hwan Park

Abstract

Objective: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). Methods: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. Results: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. Conclusion: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.

Keywords: Enthesopathy, Achilles tendinitis, Seronegative spondyloarthropathy, Ultrasonography

JRD
Jan 01, 2024 Vol.31 No.1, pp. 1~63
COVER PICTURE
Characteristic findings in interstitial lung disease (ILD) detected by lung ultrasound. Lung ultrasound can reveal characteristic findings in ILD. However, the definitive diagnosis of ILD typically requires a combination of clinical assessment, imaging studies (such as high-resuloution computed tomography [HRCT]), and sometimes a lung biopsy. (A) Traction bronchiectasis and parenchymal changes of upper lung in HRCT (arrows). (B) Corresponding changes of lung ultrasound presented by B-lines (arrows). (J Rheum Dis 2024;31:3-14)

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