The Role of Clinical and Ultrasound Enthesitis Scores in Ankylosing Spondylitis

Abstract

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disease, part of the spondyloarthritis (SpA) group, characterized by axial (spine and sacroiliac joints), entheseal, and peripheral joint involvement, which is frequently associated with extra-articular manifestations. Material and Methods: The study included a number of 30 patients diagnosed with AS according to the New York modified criteria, with history of entheseal pain, hospitalized between 2016–2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. Results: Regarding the Belgrade Ultrasound Enthesitis Score (BUSES) score and the disease activity calculated using the Ankylosing Spondylitis Disease Activity Score (ASDAS), they did not show a statistically significant association (p = 0.738). Additionally, BUSES did not have a statistically significant association with the disease activity quantified by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (p = 0.094). The Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) clinical score was not statistically associated with ASDAS (p = 0.434) nor with BASDAI (p = 0.130). The SPARCC clinical score and the BUSES ultrasound score were statistically significantly associated, registering a value of p = 0.018. Conclusions: Our study proved a significant correlation between SPARCC and BUSES, although in literature the evidence is contrasting.

The relationship between clinical parameters and ultrasonographic enthesitis assessment in patients with spondyloarthritis

“…Studies evaluating the correlation of the US scores with CRP levels and ESR have shown variable results. Some studies have failed to show any correlation;[ 9 , 12 , 17 , 18 , 36 , 37 ] however, in agreement with our study, few studies have found a relationship between the US scores and CRP levels. [ 38 - 40 ] CRP is an objective marker of active disease in SpA, and a moderate correlation between the US scores and CRP levels may indicate the role of US score as a potential marker of active disease.…”

“…In previous studies, both BUSES and lower extremity enthesis scores were found to be correlated with SPARCC. [ 16 , 17 ] Since the sonographic evaluation of axial entheses is relatively troublesome, it was wondered whether the ultrasonographic evaluation of peripheral entheses would be associated with a clinical axial enthesitis score. If the association was detected, only US peripheral evaluation might have been adequate to show also axial enthesitis.…”

“…ASDAS-CRP was moderately correlated with the MASEI and MASEI-Inflammatory scores (correlation coefficients of 0.294 and 0.308, respectively). Most of the previous studies have failed to show any correlation between US and BASDAI,[ 12 , 17 , 36 , 38 , 39 , 41 , 42 ] besides a few studies. [ 18 , 19 , 40 ] Although these studies may suggest that US may be insufficient for disease activity evaluation, some authors have also argued that the current disease activity scales may be inadequate in expressing the real disease state.…”

“…In studies comparing BUSES with clinical parameters, either clinical enthesitis scores or functionality and quality of life were not evaluated. [ 17 , 18 ] In a study utilizing MASEI, authors investigate the correlation among sonographic and clinical evaluation of entheseal sites in MASEI, disease activity, and quality of life but clinical enthesitis indices were not used, functional status was neglected, and the correlation between C-reactive protein (CRP), an important marker of inflammation and disease activity in SpA, was not investigated. [ 19 ] This study aimed to comprehensively evaluate many parameters, including disease activity, quality of life, functional status, clinical enthesitis scores, and ultrasonographical enthesitis assessment, with the MASEI index and to determine how valuable ultrasonographic enthesitis is to assess disease activity, functionality, and quality of life.…”

The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic

“… 7 The use of US with PD helps differentiate between active and inactive inflammation within joints and periarticular soft tissues thus allowing more accurate and objective assessment. 15 Together the rheumatologist and radiologist should make the most of these developments in view of the recent recommendations from EULAR that offer helpful guidance. 16 …”