Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy

Abstract

Objective: To compare ultrasonography (US) with clinical examination in the detection of entheseal abnormality of the lower limb in patients with spondyloarthropathy (SpA). Methods: 35 patients with SpA (ankylosing spondylitis 27; psoriatic arthritis 7; reactive arthritis 1) underwent independent clinical and ultrasonographic examination of both lower limbs at five entheseal sites-superior pole and inferior pole of patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis. US was performed using an ATL (Advanced Technology Laboratories, Bothell, Washington, USA) high definition imaging 3000 machine with linear 7-4 MHz and compact linear 10-5 MHz probes to detect bursitis, structure thickness, bony erosion, and enthesophyte (bony spur). An enthesitis score was formulated from these US findings giving a possible maximum total score of 36. Results: On clinical examination 75/348 (22%) entheseal sites were abnormal and on US examination 195/348 (56%) sites were abnormal. In 19 entheseal sites with bursitis on US, only five were detected by clinical examination. Compared with US, clinical examination had a low sensitivity (22.6%) and moderate specificity (79.7%) for the detection of enthesitis of the lower limbs. There was no significant correlation between the US score of enthesitis and acute phase parameters such as erythrocyte sedimentation rate (ESR) or C reactive protein (CRP). The intraobserver κ value for analysis of all sites was 0.9. Conclusions: Most entheseal abnormality in SpA is not detected at clinical examination. US is better than clinical examination in the detection of entheseal abnormality of the lower limbs in SpA. A quantitative US score of lower limb enthesitis is proposed but further studies are required to validate it in SpA.

Etanercept in the treatment of rheumatoid arthritis: clinical follow-up over one year by ultrasonography

“…In particular, before starting therapy, the median US global score was 21 [interquartile ranges (IQR), [18][19][20][21][22][23][24][25][26][27] and after 1 year of etanercept therapy was reduced to 11.2 (IQR, [8][9][10][11][12][13]. The evaluation of the knee joint is shown in Fig.…”

“…The results obtained have, however, underlined the potential role for US in the monitoring treatment response [19][20][21]. Unfortunately, the small number of patients and the brevity of follow-up make further studies necessary.…”

Is there subclinical enthesitis in early psoriatic arthritis? A clinical comparison with power doppler ultrasound

“…Several ultrasound enthesitis assessment tools have been developed in SpA cohorts, such as the Glasgow Ultrasound Enthesitis Scoring System (GUESS) tool, which examines 5 lower extremity sites (Achilles, quadriceps, superior and inferior patellar tendons, and plantar fascia) (7), and the Madrid Sonographic Enthesis Index, which assesses 6 sites (as for GUESS plus triceps tendon) (8). Using these tools, CE for enthesitis has been shown to be less sensitive than ultrasound in established SpA cohorts (7).…”

Enthesopathy – a personal perspective on its manifestations, implications and treatment

“…They can be demonstrated with ultrasound in spondyloarthropathy and psoriatic arthritis 38 – 41 . The same spectrum of features is present in large entheses like the adductors of the legs or very small entheses like the fingers.…”

“…The same spectrum of features is present in large entheses like the adductors of the legs or very small entheses like the fingers. Many are abnormal on ultrasound but typically asymptomatic 38 .…”