Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a crosssectional study comparing MASES, SPARCC and LEI

Palominos, Penélope Esther; Campos, Ana Paula Beckhauser de; Ribeiro, Sandra Lúcia Euzébio; Xavier, Ricardo Machado; Xavier, Jady Wroblewski; Oliveira, Felipe Borges de; Guerra, Bruno; Saldanha, Carla; Mancuso, Aline Castello Branco; Kohem, Charles Lubianca; Gasparin, Andrese Aline; Sampaio-Barros, Percival Degrava

doi:10.1186/s42358-019-0066-8

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Research • Adv. rheumatol. 59 • 2019 • https://doi.org/10.1186/s42358-019-0066-8 copy

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a crosssectional study comparing MASES, SPARCC and LEI

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA.

Methods:

A cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman's Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease.

Results:

Two hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (r_s 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034).

Conclusion:

In this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.

Keywords:
Spondyloarthritis; Enthesitis; Disease activity; Function

		All Centers	Hospital de Clínicas de Porto Alegre, Porto Alegre (South Brazil)	Hospital Universitário Evangélico, Curitiba (South Brazil)	Hospital Universitário Getúlio Vargas, Manaus (North Brazil)	P value
Number of patients		204	54	84	66
Male N (%)		131 (64.2)	28 (51.9)	55 (65.5)	48 (72.7)	0.057
Age in years (Mean ± SD, range)		48.6 ± 12.8 (18-87)	51.3 ± 12.2 (22-77)	47.8 ± 13.2 (18-87)	47.5 ± 12.7 (18-72)	0.213
Disease duration in years (Mean ±SD, range)		17.2 ± 10.6 (2-58)	17.4 ± 9.2 (4-44)	15.9 ±10.9 (2-55)	18.5 ± 11.2 (2-58)	0.209
Self-reported ethnicity: white N (%)		126 (61.8)	41 (75.9)	67 (79.8)	18 (27.3)	< 0.001
Patients fulfilling ASAS classification criteria for Peripheral SpA N (%)		59 (28.9)	17 (31.5)	29 (34.5)	13 (19.7)	0.123
Patients fulfilling ASAS classification criteria for Axial SpA N (%)		145 (71.1)	37 (68.5)	55 (65.5)	53 (80.3)	0.123
Patients with at least one enthesitis N(%)		124 (60.8)	44 (81.5)	43 (51.2)	37 (56.1)	0.001
Composite activity index (mean ± SD)
	BASDAI^* * Reported only for the 145 patients fulfilling ASAS criteria for axial spondyloarthritis	3.5 (2.3)	4.7 (2.6)	3.1 (2.0)	3.0 (2.2)	0.002
	ASDAS CRP^* * Reported only for the 145 patients fulfilling ASAS criteria for axial spondyloarthritis	2.3 (1.2)	2.8 (1.2)	2.4 (1.0)	1.8 (1.2)	0.001
	ASDAS ESR^* * Reported only for the 145 patients fulfilling ASAS criteria for axial spondyloarthritis	2.6 (1.0)	2.8 (1.2)	2.6 (1.0)	2.5 (1.0)	0.610
	DAS- 28 ^ Reported only for the 59 patients fulfilling ASAS criteria for peripheral spondyloarthritis	3.6 (1.4)	3.9 (1.4)	3.7 (1.5)	3.2 (1.2)	0.460
Enthesitis indices: Median (P25%, P75%), range / Mean ± SD
	MASES	1 (0, 5), 0-13/2.8 ± 3.9	3 (0,7), 0-13 / 4.4 ±4.3	0 (0, 3), 0-13 / 2.2 ± 3.5	0(0, 3), 0-13/ 2.3 ±3.6	< 0.001
	SPARCC	0 (0, 3), 0-16/2.4 ± 3.9	2 (0,6), 0-16/ 3.7 ±4.6	0 (0, 3), 0-13/ 1.8 ± 3.0	0 (0, 2), 0-16/ 2.1 ± 4.0	0.005
	LEI	0 (0, 2), 0-6/1.0 ± 1.6	0 (0, 2), 0-6/ 1.5 ± 2.0	0 (0, 1), 0-6/ 0.8 ± 1.5	0 (0, 1), 0-6/ 0.7 ±1.4	0.016

	BASDAI	BASDAI without question 4	ASDAS- ESR	ASDAS-CRP	ESR	CRP	BASFI
MASES	,572^b b correlation is significant at the 0.01 level (2-tailed)	,495^b b correlation is significant at the 0.01 level (2-tailed)	,372^b b correlation is significant at the 0.01 level (2-tailed)	,368^b b correlation is significant at the 0.01 level (2-tailed)	-,085	-,091	,465^b b correlation is significant at the 0.01 level (2-tailed)
SPARCC	,508^b b correlation is significant at the 0.01 level (2-tailed)	,440^b b correlation is significant at the 0.01 level (2-tailed)	,297^b b correlation is significant at the 0.01 level (2-tailed)	,342^b b correlation is significant at the 0.01 level (2-tailed)	-,066	-,065	,371^b b correlation is significant at the 0.01 level (2-tailed)
LEI	,447^b b correlation is significant at the 0.01 level (2-tailed)	,384^b b correlation is significant at the 0.01 level (2-tailed)	,288^b b correlation is significant at the 0.01 level (2-tailed)	,297^b b correlation is significant at the 0.01 level (2-tailed)	-,074	-,064	,314^b b correlation is significant at the 0.01 level (2-tailed)

	DAS28-ESR	ESR	CRP	HAQ
MASES	,318^a a Correlation is significant at the 0.05 level (2-tailed)	-,023	-,044	,541 ^b b Correlation is significant at the 0.01 level (2-tailed)
SPARCC	,250	-,006	-,093	,347^b b Correlation is significant at the 0.01 level (2-tailed)
LEI	,234	,008	-,002	,497^b b Correlation is significant at the 0.01 level (2-tailed)

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E-mail: rbreumatol@terra.com.br

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[1] * Correspondence: penelopepalominos@gmail.com