Elsevier

Joint Bone Spine

Volume 79, Issue 6, December 2012, Pages 586-590
Joint Bone Spine

Original article
Can we improve the diagnosis of spondyloarthritis in patients with uncertain diagnosis? The EchoSpA prospective multicenter French cohort

https://doi.org/10.1016/j.jbspin.2012.02.007Get rights and content

Abstract

Power Doppler ultrasound (PDUS) has proved to be a highly sensitive tool for assessing enthesitis in spondyloarthritis (SpA). In patients with a suspected SpA, diagnosis could be improved by detecting enthesitis with PDUS.

Objective

To evaluate the performance of PDUS for the diagnosis of SpA alone or combined with other clinical, laboratory and imaging findings in patients consulting for a suspected SpA.

Methods

Prospective, multicenter French cohort study (Boulogne-Billancourt, Brest, Caen, Grenoble, Marseille and Nancy). Outpatients consulting for symptoms suggestive of SpA (inflammatory back pain [IBP], arthritis or inflammatory arthralgia [IA], enthesitis or dactylitis [ED], HLA-B27 positive uveitis [B27+U], familiarity for SpA [Fam]) were recruited and followed up for at least 2 years. Sample size was set to 500 patients (for estimated prevalence of SpA of 30 ± 5% after 2 years). At baseline, patients were submitted to standardized physical examination, pelvic X-ray, sacroiliac joints magnetic resonance imaging (MRI), HLA-B typing, and other tests judged useful for diagnosis. For each patient, a blinded PDUS examination of 14 enthesitic sites was performed at baseline and at years 1 and 2. Patients were planned to be followed during 5 years. The diagnosis of SpA ascertained by an experts’ committee, blind to PDUS results, after at least 2 years of follow-up, with a revaluation of doubtful patients at 5 years will be used as gold standard for evaluating the diagnostic performance of PDUS and the best diagnostic procedure by combining PDUS, clinical symptoms and other tests.

Results

Between January 2005 and September 2007, 489 patients were included (96% of the target population). Nineteen patients (0.2%) retired their informed consensus or were lost to follow-up immediately after their inclusion. At baseline, mean age of the 470 remaining patients was 40 years, mean duration of symptoms was 6.1 years; 42% of them were HLA-B27+ and 63% were female. Primary inclusion criterion was IBP in 53%, IA in 27%, ED in 9%, B27+U in 8% and Fam in 4%. Follow-up is still ongoing.

Conclusion

We have set up a unique diagnostic cohort which includes the entire spectrum of SpA manifestations. By using PDUS we expected to improve the diagnostic procedure of SpA.

Section snippets

Study design

This is a French multicentre, prospective, cohort study (2 years of enrolment and 5 years of follow-up). Outpatients consecutively referred to six rheumatology departments (Boulogne-Billancourt, Brest, Caen, Grenoble, Marseille and Nancy) for symptoms suggestive of SpA, without any definite diagnosis, were considered eligible to be enrolled in this study. The six centers were selected based on the experience of investigators in conducting longitudinal epidemiological or therapeutic studies and

Results

A total of 489 (96% of the target) patients were included between January 2005 and September 2007. Two hundred and one (41%) patients were recruited in Boulogne-Billancourt, 100 (20%) in Brest, 80 (16%) in Nancy, 56 (12%) in Caen, 38 (8%) in Marseille and 14 (3%) in Grenoble. Nineteen patients retired their consensus to continue the study immediately after their inclusion. Therefore 470 patients were analyzed. Three-hundred and seventy-nine patients (81% of the latter) were evaluated at 1 year,

Discussion

This manuscript is summarizing the methodology and the baseline characteristics of the patients included in the EchoSpA study. To our best knowledge this is the first cohort settled to evaluate the diagnostic utility of a technique (i.e. ultrasound of enthesis) in patients without a definite diagnosis and in whom the target condition (i.e. SpA) is suspected. Diagnosing SpA in practice is difficult because of the absence of a reference test which permits to distinguish easily between patients

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Finding sources: this study was supported by:

  • •

    institutional grants from Programme hospitalier de recherche clinique (PHRC) with Groupe français d’étude sur les SpA (GESPA) as the sponsor, PRO-A Inserm and French Society of Rheumatology (SFR);

  • •

    unrestricted grants from Pfizer-France and Schering-Plough France.

Acknowledgments

We would like to acknowledge the following persons:

  • •

    for Ambroise-Paré Hospital: Ms Muriel Gernet, Ms Céline Dachez and M. Joseph Bikai, clinical research assistants from the Clinical Research Unit of Ambroise-Paré Hospital, Éric Vergerat for the conception and realization of the EchoSpA website, Professor Jean-Marie Le Parc, Dr Bertrand Moura and all nurses and paramedic team of the rheumatology outpatients clinic;

  • •

    for Brest Hospital: Drs Marie Noëlle Guillermit and Patrice Kervarrec of the

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