https://doi.org/10.4081/reumatismo.2024.1767
Ultrasound as a tool for the diagnosis of spondylarthritis in women
Published: 11 September 2024
Abstract Views: 549
PDF: 149
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. The journey to a diagnosis of spondyloarthritis (SpA) can be difficult for women, who often experience delays in receiving the correct diagnosis as their symptoms are frequently misinterpreted due to other conditions like osteoarthritis, fibromyalgia, or other psychosomatic disorders. The purpose of this article is to examine the challenges in the diagnosis of SpA in women and the possible role of musculoskeletal ultrasound in early diagnosis and in avoiding misdiagnosis.
Methods. We have performed a narrative review of the currently available literature on the subject.
Results. The complexity of diagnosing SpA in women is compounded by the misconception that the disease predominantly affects men. To facilitate early diagnosis and prevent misdiagnosis, it is crucial not to overlook gender differences in the clinical presentation of SpA. Since women have more peripheral and enthesitic involvement, performing an ultrasound of entheses, tendons, and joints in women with musculoskeletal symptoms that could refer to SpA may help both in the early and differential diagnosis.
Conclusions. There is a need to increase awareness among physicians of the existence of a different clinical presentation of SpA between men and women. The use of musculoskeletal ultrasound, which allows the detection of even subclinical inflammation and structural damage since early disease at the level of joints, tendons, and entheses can help make an early diagnosis and avoid misdiagnosis. Early diagnosis and timely treatment of SpA are crucial to reducing irreversible damage.
Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007; 369: 1379-90.
DOI: https://doi.org/10.1016/S0140-6736(07)60635-7
Rudwaleit M, van der Heijde D, Landewé R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-83.
DOI: https://doi.org/10.1136/ard.2009.108233
Rudwaleit M, van der Heijde D, Landewé R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70: 25-31.
DOI: https://doi.org/10.1136/ard.2010.133645
Zwolak R, Suszek D, Graca A, Mazurek M, Majdan M. Reasons for diagnostic delays of axial spondyloarthritis. Wiad Lek 2019; 72: 1607-10.
DOI: https://doi.org/10.36740/WLek201909102
Jovaní V, Blasco-Blasco M, Ruiz-Cantero MT, Pascual E. Understanding how the diagnostic delay of spondyloarthritis differs between women and men: a systematic review and metaanalysis. J Rheumatol 2017; 44: 174-83.
DOI: https://doi.org/10.3899/jrheum.160825
Garrido-Cumbrera M, Poddubnyy D, Gossec L, Gálvez-Ruiz D, Bundy C, Mahapatra R, et al. The European map of axial spondyloarthritis: capturing the patient perspective - an analysis of 2846 patients across 13 countries. Curr Rheumatol Rep 2019; 21: 19.
DOI: https://doi.org/10.1007/s11926-019-0819-8
Kennedy LG, Will R, Calin A. Sex ratio in the spondyloarthropathies and its relationship to phenotypic expression, mode of inheritance and age at onset. J Rheumatol 1993; 20: 1900-4.
Sieper J, van der Heijde D. Review: nonradiographic axial spondyloarthritis: new definition of an old disease?. Arthritis Rheum 2013; 65: 543-51.
DOI: https://doi.org/10.1002/art.37803
Ogdie A, Nowell WB, Reynolds R, Gavigan K, Venkatachalam S, de la Cruz M, et al. Real-world patient experience on the path to diagnosis of ankylosing spondylitis. Rheumatol Ther 2019; 6: 255-67.
DOI: https://doi.org/10.1007/s40744-019-0153-7
Garrido-Cumbrera M, Poddubnyy D, Gossec L, Mahapatra R, Bundy C, Makri S, et al. Gender differences in patient journey to diagnosis and disease outcomes: results from the European map of axial spondyloarthritis (EMAS). Clin Rheumatol 2021; 40: 2753-61.
DOI: https://doi.org/10.1007/s10067-020-05558-7
Slobodin G, Reyhan I, Avshovich N, Balbir-Gurman A, Boulman N, Elias M, et al. Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis. Clin Rheumatol 2011; 30: 1075-80.
DOI: https://doi.org/10.1007/s10067-011-1719-0
Myers CD, Riley JL, Robinson ME. Psychosocial contributions to sex-correlated differences in pain. Clin J Pain 2003; 19: 225-32.
DOI: https://doi.org/10.1097/00002508-200307000-00005
Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology 2020; 59: iv38-46.
DOI: https://doi.org/10.1093/rheumatology/keaa543
Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis. Semin Arthritis Rheum 2017; 47: 343-50.
DOI: https://doi.org/10.1016/j.semarthrit.2017.04.005
Riente L, Delle Sedie A, Filippucci E, Iagnocco A, Meenagh G, Grassi W, et al. Ultrasound imaging for the rheumatologist IX. Ultrasound imaging in spondyloarthritis. Clin Exp Rheumatol 2007; 25: 349-53.
Mandl P, Navarro-Compán V, Terslev L, Aegerter P, Van Der Heijde D, D’Agostino MA, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis 2015; 74: 1327-39.
DOI: https://doi.org/10.1136/annrheumdis-2014-206971
Bruyn GA, Iagnocco A, Naredo E, Balint PV, Gutierrez M, Hammer HB, et al. OMERACT definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol 2019; 46: 1388-93.
DOI: https://doi.org/10.3899/jrheum.181095
Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32: 2485-7.
Zabotti A, Sakellariou G, Tinazzi I, Idolazzi L, Batticciotto A, Canzoni M, et al. Novel and reliable DACTylitis glObal Sonographic (DACTOS) score in psoriatic arthritis. Ann Rheum Dis 2020; 79: 1037-43.
DOI: https://doi.org/10.1136/annrheumdis-2020-217191
How to Cite
Donzella, D., Bellis, E., & Iagnocco, A. (2024). Ultrasound as a tool for the diagnosis of spondylarthritis in women. Reumatismo, 76(3). https://doi.org/10.4081/reumatismo.2024.1767
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- A. Loi, S. Lisci, A. Denotti, A. Cauli, Bone mineral density in women on long-term mud-bath therapy in a Salus per Aquam (SPA) environment , Reumatismo: Vol. 65 No. 3 (2013)
- S. Gil Barato, E. de Miguel Mendieta, E. Martin-Mola, Evolution in the use of musculoskeletal ultrasonography in a Rheumatology Unit over 14 years , Reumatismo: Vol. 67 No. 1 (2015)
- G. Filippou, A. Adinolfi, A. Delle Sedie, E. Filippucci, A. Iagnocco, F. Porta, L. M. Sconfienza, S. Tormenta, V. Di Sabatino, V. Picerno, B. Frediani, Radiologists and rheumatologists on performing and reporting shoulder ultrasound: from disagreement to consensus , Reumatismo: Vol. 66 No. 3 (2014)
- G. Lapadula, A. Marchesoni, F. Salaffi, R. Ramonda, C. Salvarani, L. Punzi, L. Costa, F. Caso, D. Simone, G. Baiocchi, C. Scioscia, M. Di Carlo, R. Scarpa, G. Ferraccioli, Evidence-based algorithm for diagnosis and assessment in psoriatic arthritis: results by Italian DElphi in psoriatic Arthritis (IDEA) , Reumatismo: Vol. 68 No. 3 (2016)
- R.C. Ansell, T. Shuto, N. Busquets-Perez, E.M.A. Hensor, H. Marzo-Ortega, D. McGonagle, The role of biomechanical factors in ankylosing spondylitis: the patient’s perspective , Reumatismo: Vol. 67 No. 3 (2015)
- A. Iagnocco, F. Ceccarelli, G. Cuomo, A. Delle Sedie, G. Filippou, E. Filippucci, W. Grassi, F. Porta, Garifallia Sakellariou, on behalf of the Musculoskeletal Ultrasound Study Group of SIR, Diffusion and applications of musculoskeletal ultrasound in Italian Rheumatology Units , Reumatismo: Vol. 65 No. 1 (2013)
- G. Biasi, V. Di Sabatino, A. Ghizzani, M. Galeazzi, Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia , Reumatismo: Vol. 66 No. 1 (2014)
- A. Fassio, L. Idolazzi, M.A. Jaber, C. Dartizio, O. Viapiana, M. Rossini, D. Gatti, The negative bone effects of the disease and of chronic corticosteroid treatment in premenopausal women affected by rheumatoid arthritis , Reumatismo: Vol. 68 No. 2 (2016)
- W. Häuser, F. Wolfe, Diagnosis and diagnostic tests for fibromyalgia (syndrome) , Reumatismo: Vol. 64 No. 4 (2012)
- G. Filippou, V. Picerno, A. Adinolfi, V. Di Sabatino, I. Bertoldi, M. Galeazzi, B. Frediani, Change perspective to increase diagnostic accuracy of ultrasonography in calcium pyrophosphate dihydrate deposition disease! A new approach: the axial scan of the meniscus , Reumatismo: Vol. 66 No. 4 (2014)
You may also start an advanced similarity search for this article.
