Global Advanced Research Journal of Medicine and Medical Sciences (GARJMMS) ISSN: 2315-5159
November 2015 Vol. 4(11), pp. 493-504
Copyright © 2015 Global Advanced Research Journals


Full Length Research Paper 

The Role of Musculoskeletal Ultrasound scanning of axial and peripheral joints of Ankylosing Spondylitis patients in short-term monitoring response to TNF-α antagonist therapy:  Clinical Trial

Nayera Z. Saber1*, Takwa  B. Younis1 and Yosra A. Ibrahim2

1Physical Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

*Corresponding Author E-mail:; Telephone:  + 2 01117288825

Accepted 26 November, 2015


Background: Although musculoskeletal Ultrasound (MSK US) allows visualization of peripheral arthritis and enthesitis, its role in the assessment of axial manifestations remain minimal. Few recent studies used duplex and color Doppler to detect synovitis in sacroiliac joint in Ankylosing Spondylitis (AS). Objective: This study aims to evaluate the value of MSK US scanning of both axial and peripheral arthritis as well as enthesitis in AS patients in  short-term  monitoring response to TNF-α antagonist therapy and to detect the best prognostic predictors of good response to treatment. Methods: Twenty patients  with ankylosing spondylitis, diagnosed according to Modified 1984 New York criteria. Clinical assessment of axial , peripheral joints and enthesis with emphasis on disease activity with BASDAI, ASDAS-CRP and BASMI. Imaging by plain X-rays of spines and S.I joints using BASRI score and by US using SOLAR score for sacro-iliac (S.I), hip and knee joints as well as four sites of enthesis. These regions were assessed by grey scale US (GSUS) and power Doppler US (PDUS) according to EULAR guidelines. All patients were assigned to anti TNFα therapy for 6 months then clinical and imaging re-assessment were done. Results: Twenty patients with AS (18 males and 2 females), their mean age was 34.3± 9.5261, mean disease duration was 9.65 ±4.3682, mean BASDAI was 7.225± 1.2191 and ASDAS CRP was 4.205± 0.620 with evidence of active sacroiliitis, hip and knee synovitis as well as increased plantar fascia (PF) and tendo Achillis (TA) thickness by GSUS and PDUS. After six months of anti TNFα therapy, all patients were significantly improved regarding BASDAI, BASMI, GSUS of knee, TA and PF thickness (t= 9.234, t = 3.911, t= 10.258, t= 6.948, t= 8.076, p ˂0.01) respectively as well as S.I synovitis by PDUS (p˂ 0.05). To elaborate efficacy of treatment after 6 months, we measured major clinical response by BASDAI 50% and clinically important improvement by ∆ ASDAS ≥1.1, and we noticed that ∆ ASDAS ≥1.1 was significantly correlated with age, peripheral arthritis, baseline BASDAI, BASMI, ESR, number of enthesis, BASRI  total and S.I and hip synovitis (p ˂0.05). Also, we noticed that baseline high ESR and increased number of enthesis as well as initial ASDAS >2.1 and PF thickness > 4mm were best predictors of good response to anti TNFα therapy. Conclusion: MSK US is considered a promising tool for assessing axial, peripheral arthritis and enthesopathy in AS patients and effectively help in monitoring short term effect of anti TNFα therapy

Keywords: Ankylosing spondylitis, US scanning, sacroiliitis, enthesopathy, anti TNF-α, therapy


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