Hallazgos ecogr?ficos en entesis de pacientes con artritis psori?sica y controles sanos, servicio de reumatolog?a del Hospital Docente Padre Billini, Santo Domingo, Rep?blica Dominicana, enero-julio 2022

Abstract

[Espa?ol] La artritis psori?sica (APs) es una enfermedad inflamatoria de patolog?a inmunol?gica y etiolog?a desconocida con caracter?sticas sist?micas en donde predomina la afectaci?n articular en pacientes que padecen psoriasis. 1 El diagn?stico se realiza con mayor frecuencia identificando caracter?sticas musculoesquel?ticas inflamatorias en las articulaciones, entesis o la columna, en presencia de psoriasis cut?nea y / o ungueal, y en la ausencia habitual de factor reumatoide.2 Cada vez se reconoce m?s la importancia de la entesitis como la lesi?n patol?gica clave que sustenta la patogenia de la APs. El grupo OMERACT (Outcome Measures in Rheumatology) en conjunto con el grupo de trabajo en ecograf?a USGW (Ultrasound Working Group) han desarrollado una clasificaci?n para las lesiones dividi?ndolas en inflamatorias y estructurales,4 as? mismo el ?ndice de Leeds es una herramienta que eval?a 6 entesis: Aquileas, c?ndilos femorales mediales y epic?ndilos laterales, en la cual se busca encontrar la presencia de Entesitis, Power Doppler, Irregularidades y Grosor del tend?n Aquileo.5 Objetivo: Describir hallazgos ecogr?ficos en entesis de pacientes con Artritis psori?sica y controles sanos. M?todos: Estudio descriptivo, transversal. De la cohorte de pacientes del servicio de Reumatolog?a del Hospital Docente Padre Billini (HDPB). Se evaluaron los pacientes de la consulta externa del servicio de Reumatolog?a en enero-julio 2022. Criterios de inclusi?n: > de 18 a?os, cumplir criterios de clasificaci?n de APs de acuerdo con los criterios CASPAR 2009. Criterios de exclusi?n: pacientes con diagn?stico de otras espondiloartritis, antecedentes quir?rgicos, ortesis, inmovilizaci?n y material de osteos?ntesis de las entesis evaluadas, e infiltraci?n menor de 3 meses de las entesis en estudio. Se realizaron ecograf?as por un reumat?logo experto en ecograf?a musculoesquel?tica, de 6 entesis de acuerdo con el ?ndice de Leeds (Leeds University Enthesis Index) donde se evaluaron: epic?ndilos humerales bilaterales, ambos cu?driceps y ambos tendones aqu?leos, en busca de irregularidades, entesofitos, Power Doppler, y engrosamiento del tend?n calc?neo. El an?lisis estad?stico fue realizado en el programa SPS23. Resultados: De la cohorte del servicio de Reumatolog?a del HDPB, 35 cumplieron criteriosde inclusi?n, evalu?ndose 420 entesis 68.6% (24) femeninas, 31.4% (11) masculinos, etnia afroamericanos, media de edad 53.7 +11.75 a?os, duraci?n de la enfermedad 7.9 a?os, sobre peso 68.6% (24), HTA 8.6% (3), dislipidemia 57.8% (26), DM 11.4% (4), fumadores 3.84% (2), csDMARD?s 85.7% (30): metotrexate 85.7% (30), bDMARD?s 85.7% (30): Secukinumab 37.1% (13), adalimumab 42.9% (15), golimumab 5.7% (2). Lesiones estructurales 39.8% (167), Irregularidades 22.6% (95), Entesofitos 20.5% (86), Engrosamiento 13.3% (56), PD 0.2% (1). Irregularidades: Calc?neo D/I: 57.1% (20), Epic?ndilo I/D 42.9% (15) / 40% (14), Cu?driceps I/D: 40% (14) / 34.3% (12). Entesofitos: Calc?neo D/I 60% (21) /62.9% (22), Epic?ndilo I/D 40% (14) / 37.1% (13), Cu?driceps D/I 45.7% (16) /28.6% (10). Engrosamiento calc?neo I/D 85.7% (30) / 74.3% (26). Power Doppler epic?ndilo lateral Izquierdo 2.9% (1). Controles sanos: Lesiones estructurales 36.2% (152), Irregularidades 14.3% (60), Entesofitos 15.5% (65), Engrosamiento Calc?neo 6.4% (27). Irregularidades 22.6% (95), Entesofitos 20.5% (86), Engrosamiento 13.3% (56), PD 0.2% (1). Irregularidades: Calc?neo I/D 31.4% (11) /34.1% (12), Epic?ndilo I/D 28.6% (10), Cu?driceps D/I 17.1% (6) /31.4% (11). Entesofitos: Calc?neo D/I 42.9% (15), Cu?driceps D/I 45.7% (16) /28.6% (10), Epic?ndilo I/D 25.7% (9) / 22.9% (8). Engrosamiento calc?neo I/D 42.9% (15) /34.3% (12). Conclusiones: Nuestro estudio observ? un predominio de las lesiones estructurales en los pacientes con Artritis psori?sica. El hallazgo m?s frecuente fue la irregularidad enteseal, encontr?ndose predominantemente en la entesis del calc?neo. No se encontr? asociaci?n con el ?ndice de masa corporal, ni con la actividad cl?nica. Dentro de factor confusor se debe determinar actividad laboral, que puede sugerir cambios mec?nicos.

[English] Psoriatic arthritis (PsA) is a systemic inflammatory disease with innate and acquired immune activity and unknown etiology, associated or not with the presence of psoriasis. 1 Diagnosis is made by identifying joint, entheseal, or axial inflammatory musculoskeletal features, in the usual absence of rheumatoid factor.2 The importance of enthesitis as the target tissue underlying the pathogenesis of PsA is increasingly recognized. The OMERACT group (Outcome Measures in Rheumatology) and the USGW (Ultrasound Working Group) have developed a classification for entheseal lesions, dividing them into inflammatory and structural. 4 The Leeds University Enthesis Index (LEI) is a tool that evaluates 6 entheses: calcaneus, medial femoral condyles and lateral epicondyles, in which it seeks to find the presence of Enthesitis, Power Doppler, Irregularities and Thickness of the calcaneus tendon. 5 Objective: To describe the ultrasound findings in entheses of patients with psoriatic arthritis. Methods: Descriptive, cross-sectional, observational study. From the cohort of patients from the Rheumatology service of the Hospital Docente Padre Bellini (HDPB), patients from the outpatient clinic from January to July 2022 were evaluated. Inclusion criteria: > 18 years old, diagnosis of PsA by CASPAR 2009 criteria. Exclusion criteria: diagnosis of other spondyloarthritis, surgical history with osteosynthesis material of the evaluated entheses, orthoses, immobilization, infiltration of less than 3 months in the entheses evaluated. Ultrasounds were performed by a rheumatologist expert in patients with diagnosis of psoriatic arthritis compared to control group of healthy people matched by age and sex of the 6 entheses according to the LEI: bilateral epicondyles, insertion of the quadriceps and insertion of the calcaneus, in search of irregularities, enthesophytes, Power Doppler, and thickening of the calcaneal tendon, with the ultrasound machine Siemmens Acuson X 150, with 13 mHz transducer. Descriptive statistics were performed using SPSS V25 Results: Of the HDPB Rheumatology service cohort, 35 met the inclusion criteria, 420 entheses were evaluated, 68.6% (24) female, 31.4% (11) male, 100% African American, mean age 53.7+11.7 years, mean age disease 7.9 years, overweight 68.6% (24), dyslipidemia 57.8% (26), DM 11.4% (4), hypertension 8.6% (3), smokers 3.84% (2), methotrexate 85.7% (30), bDMAR's 85.7% (30): Secukinumab 37.1% (13), adalimumab 42.9% (15), golimumab 5.7% (2). Ultrasound findings: Structural lesions 39.8% (167), Irregularities 22.6% (95): Calcaneus 57.1% (20), Epicondyle 30.5%, Quadriceps, Enthesophytes 22.8 % (96): Calcaneus 50% (43) Epicondyle 31% (27) Quadriceps 30% (26), Calcaneal thickening 13.3% (56), PD 0.2% (1): left epicondyle. Control group: Structural lesions 36.2% (152), Irregularities 14.3% (60), Enthesophytes 15.5% (65) Conclusion: Our study mainly observed structural lesions in patients with psoriatic arthritis vs control group. The most frequent finding was entheseal irregularity of the calcaneus. No association was found with body mass index or with clinical activity. Within the confounding factor, labor activity and dominant hemibody should be determined, which may suggest mechanical changes.