Clinical value of ultrasonographic assessment of extensor tendon enthesitis of distal interphalangeal joints in patients with inflammatory arthritis

doi:10.3877/cma.j.issn.1672-6448.2024.04.009

Abstract

Abstract:

Objective

To investigate the diagnostic utility of ultrasonic identification of enthesitis of the extensor tendon of the distal interphalangeal joint (DIP) in patients with inflammatory arthritis (IA).

Methods

A total of 140 patients (IA group) were recruited from the First Affiliated Hospital of Fujian Medical University between June 2021 and June 2022, comprising 102 patients with rheumatoid arthritis (RA), 38 patients with spondyloarthritis (SpA), and 104 patients with osteoarthritis (OA). The gray scale and power Doppler (PDUS) ultrasonic features of DIP extensor tendon attachment sites were compared between the IA and OA groups. Univariate and multivariate logistic regression was used to identify the independent predictors of IA. The ultrasonic detection rate of DIP extensor tendon enthesitis was compared between the RA and SpA groups.

Results

Multivariate logistic analysis indicated that the ultrasonic characteristics of DIP extensor tendon attachment points (specifically tendon thickness, bone hyperplasia, and bone erosion) were not independent predictors of IA in IA patients and OA patients (P>0.05). The positive PDUS signal of DIP extensor tendon enthesitis was identified to be an independent predictor of IA (odds ratio=23.20, 95% confidence interval: 10.37-51.92, P<0.01). The rate of ultrasonic detection of DIP extensor tendon enthesitis in the RA and SpA groups was 67.64% (69/102) and 84.21% (32/38), respectively, with no statistically significant difference between the two groups (χ²=3.13, P>0.05).

Conclusion

The use of ultrasonic detection, particularly PDUS, for identifying DIP extensor tendon enthesitis shows promise in the clinical differentiation of IA and OA.

Key words: Distal interphalangeal joint, Inflammation arthritis, Osteoarthritis, Ultrasonography, Enthesitis, Power Doppler ultrasound

Yiran Gong, Wenting Li, Yabin Fang, Kaiyi Yang, Juxin He, Shuqiang Chen. Clinical value of ultrasonographic assessment of extensor tendon enthesitis of distal interphalangeal joints in patients with inflammatory arthritis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(04): 408-413.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2024.04.009

https://chaosheng.cma-cmc.com.cn/EN/Y2024/V21/I04/408

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References 17

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组别	例数	年龄（岁，）	男性[例（%）]	病程[年，M（P₂₅，P₇₅）]	CRP[mg/L，M（P₂₅，P₇₅）]	ESR[mm/h，M（P₂₅，P₇₅）]	RF阳性[例（%）]	ACPA阳性[例（%）]
IA组	140	49.24±15.32	47（33.6）	2.00（1.00，2.88）	14.11（6.00，19.60）	43.00（21.00，77.00）	71（50.71）	67（64.42）
OA组	104	57.60±8.69	30（28.8）	1.17（1.00，3.00）	6.31（5.00，7.77）	18.00（11.75，28.00）	-	-
统计值		t=36.24	χ²=0.62	Z=0.29	Z=6.20	Z=7.05	-	-
P值		<0.01	0.487	0.77	<0.01	<0.01	-	-

组别	例数	年龄（岁，）	男性[例（%）]	病程[年，M（P₂₅，P₇₅）]	CRP[mg/L，M（P₂₅，P₇₅）]	ESR[mm/h，M（P₂₅，P₇₅）]	RF阳性[例（%）]	ACPA阳性[例（%）]
IA组	140	49.24±15.32	47（33.6）	2.00（1.00，2.88）	14.11（6.00，19.60）	43.00（21.00，77.00）	71（50.71）	67（64.42）
OA组	104	57.60±8.69	30（28.8）	1.17（1.00，3.00）	6.31（5.00，7.77）	18.00（11.75，28.00）	-	-
统计值		t=36.24	χ²=0.62	Z=0.29	Z=6.20	Z=7.05	-	-
P值		<0.01	0.487	0.77	<0.01	<0.01	-	-

组别	例数	肌腱厚度[mm，M（P₂₅，P₇₅）]	骨质增生[例（%）]	骨侵蚀[例（%）]	PDUS血流信号阳性[例（%）]
IA组	140	1.10（0.86，1.20）	69（49.29）	8（5.71）	92（65.71）
OA组	104	1.10（0.90，1.25）	64（61.54）	4（3.85）	8（7.69）

组别	例数	肌腱厚度[mm，M（P₂₅，P₇₅）]	骨质增生[例（%）]	骨侵蚀[例（%）]	PDUS血流信号阳性[例（%）]
IA组	140	1.10（0.86，1.20）	69（49.29）	8（5.71）	92（65.71）
OA组	104	1.10（0.90，1.25）	64（61.54）	4（3.85）	8（7.69）

因素	回归系数	标准误	Wald卡方值	OR值	95%CI	P值
肌腱厚度	0.12	0.40	0.08	0.89	0.40~1.97	0.78
骨质增生	0.45	0.26	2.95	0.64	0.38~1.07	0.09
骨侵蚀	0.42	0.63	0.44	1.52	0.44~5.17	0.58
PDUS血流信号阳性	3.14	0.41	58.83	23.00	10.32~51.25	<0.01

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