Power Doppler ultrasonography assessment of entheses in spondyloarthropathies: response to therapy of entheseal abnormalities.

OBJECTIVE: To investigate the response to therapy of entheseal abnormalities assessed with power Doppler (PD) ultrasound (US) in spondyloarthropathies (SpA). METHODS: A total of 327 patients with active SpA who were starting anti-tumor necrosis factor (TNF) therapy were prospectively recruited at 35 Spanish centers. A PDUS examination of 14 peripheral entheses was performed by the same investigator in each center at baseline and at 6 months. The following elementary lesions were assessed at each enthesis (presence/absence): morphologic abnormalities (hypoechogenicity and/or thickening), entheseal calcific deposits, cortical abnormalities (bone erosion and/or proliferation), adjacent bursitis and intraenthesis and perienthesis (tendon body and/or bursa) PD signal. Response to therapy of each elementary lesion was assessed by calculating change in the cumulative presence from baseline to 6 months. Intraobserver reliability of PDUS was evaluated by blindly assessing the stored baseline images 3 months after the real-time examination. RESULTS: Complete data were obtained on 197 patients who received anti-TNF therapy for 6 months. In 91.4% of the patients there were gray-scale or PD elementary lesions at baseline and at 6 months. Cumulative entheseal morphologic abnormalities, intraenthesis PD, perienthesis PD, and bursitis showed a significant decrease from baseline to 6 months (p < 0.05). There was high intraobserver reliability for all elementary lesions (interclass correlation coefficient > 0.90, p < 0.0005). CONCLUSION: Entheseal morphologic abnormalities, PD signal, and bursitis were US abnormalities that were responsive to anti-TNF therapy in SpA. PDUS can be a reproducible method for multicenter monitoring of therapeutic response in enthesitis of SpA.

Aspectos psicopatológicos de la fibromialgia / Psychopathology and fibromyalgia

El síndrome de la fibromialgia (FM) es un trastorno de dolor crónico cuya etiología se desconoce. Tradicionalmente se ha señalado la alta incidencia de psicopatología en los pacientes fibromiálgicos. No obstante existe controversia acerca del tipo de psicopatología predominante (algunos estudios apuntan que los cuadros depresivos se dan con mayor frecuencia en la FM que en otros cuadros de dolor crónico, mientras que otros autores no encuentran diferencias) y a su significación (psicopatología como reacción de estrés ante el dolor crónico o parte del mismo mecanismo fisiopatológico). El presente trabajo revisa la literatura al respecto e incluye los datos preliminares de un proyecto en marcha de colaboración entre las secciones de Reumatología y Psiquiatría del Hospital de Jerez (Cádiz) del Servicio Andaluz de Salud, que tiene como objetivo el estudio de los aspectos psicopatológicos de los cuadros reumáticos cronificados entre los que la FM tiene una importante incidencia asistencial. Los resultados apuntan a una relación entre ansiedad y fibromialgia en detrimento de la relevancia de la depresión (AU)