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Article Type

Original Study

Abstract

Objective The aims were to assess prevalence of enthesitis among different subtypes of early spondyloarthropathy (SpA) and to evaluate specificity of entheseal involvement in such patients using ultrasonography and power Doppler. Background Enthesitis is one of the characteristic etiopathogenic manifestations of spondyloarthritis; however, in clinical practice, its presence often goes unnoticed. Ultrasound (US) can visualize most of the relevant enthesitis-associated pathologies such as bone erosions, calcification, bursitis, tendon structure, and thickness. Patients and methods A total of 80 patients with SpA with early disease duration and 20 controls (10 with mechanical low back pain and 10 with rheumatoid arthritis) of matched age and sex underwent ultrasonographic evaluation of entheses and were scored according to Madrid Sonographic Enthesitis Index. Patients were distributed as 36 patients with ankylosing spondylitis, 18 patients with reactive arthritis, and 26 patients with psoriatic arthritis. Results On clinical examination of entheses, 22.5% of the examined sites were abnormal as compared with US, which achieved higher sensitivity of 62.5%. Mean US score was significantly higher in patients with SpAs (22.6 ± 6.34) as compared with controls (P < 0.001). Elemental US lesions (calcification, Doppler, bone erosion, and bursae) also achieved significant difference between both groups (P < 0.003, 0.001, 0.003, 0.001, respectively). Disease duration but not human leukocyte antigen-B27 positivity had a significant correlation with the US score. Conclusion The entheses US score may be useful for improving the diagnostic accuracy of early SpA, which is difficult to diagnose.

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