https://doi.org/10.4081/reumatismo.2024.1767

Ultrasound as a tool for the diagnosis of spondylarthritis in women

Vol. 76 No. 3 (2024)
Published: 11 September 2024
Musculoskeletal ultrasound, women, SpA diagnosis
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Authors

D. Donzella
Department of Clinical and Biological Sciences, Academic Rheumatology Center, University of Turin, Ospedale Mauriziano, Turin, Italy.
E. Bellis
Department of Clinical and Biological Sciences, Academic Rheumatology Center, University of Turin, Ospedale Mauriziano, Turin, Italy.
A. Iagnocco
annamaria.iagnocco1@gmail.com
https://orcid.org/0000-0001-5592-724X
Department of Clinical and Biological Sciences, Academic Rheumatology Center, University of Turin, Ospedale Mauriziano, Turin, Italy.

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.

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Europe PMC
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
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