Prevalence and clinical associations of ultrasound-confirmed enthesitis in systemic lupus erythematosus

Fagni F, Bettiol A, Silvestri E, Fedi R, Palermo A, Urban ML, Mazzotta R, Malandrino D, Bello F, Mattioli I, Simon D, Di Scala G, Schett G, Prisco D, Emmi G (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Rheumatology Oxford University Press

DOI: 10.1093/rheumatology/kead123

Abstract

Objectives To assess the prevalence of US-confirmed enthesitis in a cohort of patients with SLE and to analyse the clinical associations to enthesitis during the course of SLE. Methods In a retrospective analysis of the SLE cohort of the Lupus Unit of the Careggi University Hospital, US examinations of SLE patients presenting with tender and/or swollen joints were retrieved to assess the presence of enthesitis. Patients with US-proven enthesitis were compared with SLE controls with tender and/or swollen joints who showed no US evidence of enthesitis. Clinical and laboratory features were compared at disease onset and during follow-up. Results A total of 400 patients fulfilling EULAR/ACR classification criteria for SLE were assessed. Of these, 106 underwent articular US examination. Evidence of enthesitis was found in 31/106 (29.2%) patients. Seventy-one patients without US-enthesitis were included as controls; four were excluded due to lack of follow-up data. Laboratory and clinical features were comparable between cases and controls at disease onset. Throughout a median follow-up of 10.0 (interquartile range [IQR] 8.3-23.3) years for cases and 12.4 (IQR 7.2-13.3) years for controls, patients with enthesitis were less likely to develop renal involvement (22.6% vs 46.5%, P = 0.028) and failed B cell depletion more frequently (75.0% vs 0%). Conclusion In SLE patients with clinically active joints, US-proven enthesitis is a fairly common finding. Enthesitis in SLE could be the hallmark of a distinct disease phenotype with less renal involvement, more arthritis and low response to anti-CD 20 therapy, potentially requiring a tailored treatment.

Authors with CRIS profile

Filippo Fagni Department of Medicine 3 – Rheumatology and Immunology David Simon Department of Medicine 3 – Rheumatology and Immunology Georg Schett Lehrstuhl für Innere Medizin III

Involved external institutions

Università degli Studi di Firenze / University of Florence IT Italy (IT) Careggi University Hospital / Azienda Ospedaliero Universitaria Careggi IT Italy (IT)

How to cite

APA:

Fagni, F., Bettiol, A., Silvestri, E., Fedi, R., Palermo, A., Urban, M.L.,... Emmi, G. (2023). Prevalence and clinical associations of ultrasound-confirmed enthesitis in systemic lupus erythematosus. Rheumatology. https://doi.org/10.1093/rheumatology/kead123

MLA:

Fagni, Filippo, et al. "Prevalence and clinical associations of ultrasound-confirmed enthesitis in systemic lupus erythematosus." Rheumatology (2023).

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