| Part ⅠComparation of Ultrasonic Imaging of Enthesopathy in the Lower Limbs in Patients with Psoriasis and Psoriatic ArthritisObjective:To investigate the characters and differences of enthesopathy of ultrasonic imaging in the lower limbs in patients with psoriasis(Ps) and psoriatic arthritis(PsA), and to explore the risk factors of Ps developing into PsA in the future.Methods:Sex-and age-matched patients with Ps, PsA and HCs visting to the dermatological and rheumatic outpatient department of the Chinese PLA general hospital were enrolled. Ultrasound of the lower limbs entheses (quadriceps insertions, patellar tendon origins and insertions, Achilles and plantar fascia insertion) was performed using a GE Logiq e R6 machine, both with a linear probe at 4-12 MHz. And then a comparation of ultrasonic imaging of the lower limbs entheses between the three groups was made.Results:(1) There were 45 Ps,45 PsA cases and 45 HCs consecutively recruited in the study. 230 of 450 enthesal sites were abnormal in Ps group, compared with 233 and 114 abnormals sites respectively in PsA and HCs groups (P< 0.001).(2) The presence of osteophyte, erosion and Power Doppler (PD) signal in Achilles tendon were significantly higher in PsA than that in Ps (P<0.05) and HCs (P<0.01).(3) Logistic regression results showed a longer course of psoriasis was the risk factor of developing into PsA (regression coefficient was 0.121, OR=1.13,P<0.001).(4) The Glasgow Ultrasound Enthesitis Scoring System(GUESS) score was significantly higher in patients with Ps and PsA than in that in HCs (P<0.01). However, there were no differences in Psoriasis Area and Severity Index (PASI) and GUESS score between Ps and PsA.(5) No differences were found in the presence of enthesopathy between Ps/PsA with or without nail disease (P=0.125,0.10).Conclusion:(1) The frequency of enthesopathy in the lower limbs was significantly higher in Ps and PsA who were absence of extremity musculoskeletal symptoms than HCs when detected by ultrasonography.(2) The presence of osteophyte, erosion and PD signal in Achilles tendon were significantly lower in Ps than in PsA.(3) A longer course of psoriasis may be the predictive signal of developing into PsA in the future.Part ⅡSonographic Evaluation of subclinical enthesopathy of the Lower Extremity in Patients Undergoing HemodialysisObjective:Musculoskeletal disease can be a secondary lesion occured in patients who are suffering long-term hemodialysis, which seriously affects the patients’ quality of life. In this paper, we investigate the ultrasonic manifestations and risk factors of subclinical enthesopathy at the lower limb level in hemodialysis patients, in order to provide important reference information for early diagnosis of symptomatic enthesopathy.Methods:Ultrasonographic imaging features of entheses in lower extremity of 36 hemodialysis patients (hemodialysis group) and 36 healthy controls (control group) were observationaliy reviewed, and the relationship between ultrasound results and the clinical as well as laboratory data were analyzed.Results:(1) The body mass index (BMI) in average of hemodialysis group was significantly less than the control group (t=2.8, P<0.01).(2) The presence of subclinical entheses lesions, thicker, osteophyte and power doppler signal of entheses in lower extremity were significantly higher in hemodialysis group than in control group (x 2=101.8,41.5,28.2,4.2, P<0.05). The GUESS score was significantly higher in patients with hemodialysis than in healthy controls(t=-5.3, P<0.001).(3) There was a significant correlation between enthesopathy and age as well as BMI (F=12.3, P<0.05), while no significant correlation between enthesopathy and Calcium, phosphorus, creatinine, triglycerides, parathormone, beta-2-microglobulin, C-reactive protein were noted (P>0.05).Conclusion:(1) Ultrasound can be effectively used in finding subclinical enthesopathy of lower extremity in hemodialysis patients.(2) Combined with ultrasound results, Older age and higher BMI will provide important reference information for the development of symptomatic dialysis-related enthesopathy. |
