PT  - JOURNAL ARTICLE
AU  - Philip J.  Mease
AU  - Filip Van den Bosch
AU  - Joachim Sieper
AU  - Yinglin Xia
AU  - Aileen L.  Pangan
AU  - In-Ho Song
TI  - Performance of 3 Enthesitis Indices in Patients with Peripheral Spondyloarthritis During Treatment with Adalimumab
AID  - 10.3899/jrheum.160387
DP  - 2017 Mar 15
TA  - The Journal of Rheumatology
PG  - jrheum.160387
4099  - http://www.jrheum.org/content/early/2017/03/07/jrheum.160387.short
4100  - http://www.jrheum.org/content/early/2017/03/07/jrheum.160387.full
AB  - Objective To evaluate the validity of enthesitis indices in patients with peripheral spondyloarthritis (pSpA). Methods The ABILITY-2 study evaluated the efficacy of adalimumab (ADA) versus placebo (PBO) in patients with active pSpA over 12 weeks. Patients received open-label ADA for an additional 144 weeks. Twenty-nine enthesitis sites used in 3 enthesitis scoring systems [Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)] were assessed; discriminatory capacity and treatment response at Week 12 were calculated by standardized mean difference (SMD) and Guyatt’s effect size (ES). Sites showing resolution or new-onset enthesitis from baseline to Week 12 were analyzed. Results Overall, 165 patients (ADA, n = 84; PBO, n = 81) were randomized; 143 had ≥ 1 enthesitis site at baseline. The LEI (SMD –0.73, ES –1.07) and SPARCC (SMD –0.56, ES –0.99) enthesitis indices showed higher discriminatory ability and treatment response than MASES (SMD –0.32, ES –0.81). At Week 12, among sites that were positive at baseline, significantly more (p < 0.05) showed resolution among patients treated with ADA versus PBO in the Achilles tendon (60.4% and 36.5%, respectively), medial epicondyle (73.2%, 48.7%), lateral epicondyle (80.6%, 52.8%), and iliac crest (73.5%, 47.2%). Among negative sites at baseline, significantly less (p < 0.05) new-onset enthesitis was observed with ADA versus PBO for Achilles tendon (3.6% and 10.9%, respectively), greater trochanter (3.4%, 14.4%), lateral epicondyle humerus (4.7%, 15.1%), medial femoral condyle (1.6%, 9.2%), and quadriceps insertion superior patella (1.5%, 7.0%). Conclusion The LEI and SPARCC enthesitis indices showed better discriminatory capacity and treatment response in patients with pSpA versus MASES, likely because these indices contain more peripheral sites. Trial registration number: ClinicalTrials.gov NCT01064856.