| Objective:Enthesitis is a hallmark of spondyloarthritis (SpA). The prevalence of peripheralenthesitis revealed by clinical findings is usually different. However, imaging plays anincreasingly important role in the diagnosis of enthesitis. The aim of the study is tocompare ultrasound (US) with clinical examination in the detection of peripheralentheseal abnormalities in spondyloarthritis.Methods：SpA patients from our rheumatology department, between October2011andJanuary2012, were recruited. All of the patients underwent independent clinical andultrasonic examinations of symphysis pubis，bilateral sternoclavicular joint and thelower limbs(quadriceps tendon, proximal patellar ligament, distal patellar ligament,Achilles tendon and plantar aponeurosis).Results:（1）36SpApatients were enrolled，the mean age of patients was(22±5.49) years，the mean duration was(4.68±4.00)years.（2） On US examination,156/466(33.48%) entheseal sites were abnormal, and onclinical examination,45/466(9.66%) entheseal sites were abnormal (P=0.000).The most frequently involved sites were distal patellar ligament enthesis (75%),symphysis pubis (64.71%) and Achilles tendon enthesis(51.34%). Bursitis(64%) is the most common entheseal abnormality in the lower limbs.（3） Tendon thickness (P=0.007) and bone erosion (P=0.000) are statisticallydifferent between the group with clinical entheseal involvement and the group without clinical entheseal involvement. Among all the changes detected by US,tendon thickness (P=0.022) and bone erosion (P=0.000) were the predictors ofclinical signs of enthesis.Conclusion:（1） US is better than clinical examination in the detection of entheseal involvementin SpA. When compared with Achilles tendon enthesis, entheseal abnormalityis not less common in the distal patellar ligament enthesis, sternoclavicularjoint and symphysis pubis.（2） Tendon thickness and bone erosion detected by US were the predictors ofclinical signs of enthesis, and US could complement the clinical examinationfor better evaluation. Objective:Glasgow ultrasound enthesitis scoring system (GUESS) is one of the most commonsystems for evaluating the enthesis involvement, but its diagnosis value is not wellestablished. The aim of present study is to evaluate the accuracy of enthesis ultrasoundfor the diagnosis of spondyloarthiritisMethods:SpA patients and healthy controls (HC) between February2012and October2012were recruited, all of whom underwent ultrasound examination of bilateral quadricepstendon, proximal patellar ligament, distal patellar ligament, Achilles tendon and plantaraponeurosis. The following changes such as tendon thickness, bone erosions, bursitis,enthesophytes and power Doppler signals were assessed by both GUESS and PowerDoppler score (PDS), which compose the global score(TGS). The diagnostic accuracywas analyzed by the receiver operating characteristic (ROC) curves.Results:（1）60SpA patients and24healthy controls were enrolled;52of the patients were male, the mean age was (22.0±4.9) years and the mean duration was (4.3±4.3)years. In contrast,20of the controls were male with mean age of (28.7±5.0)years.（2） The mean (SD) value of the GUESS score was4.75(2.81) in SpA group and2.08(1.41) in HC group (P<0.001). The ROC area under the curve is0.779(P<0.005), the best cut-off point was3.5points, which achieved a sensitivity of65.0%and a specificity of91.7%. TGS was (5.58±3.61) and (2.08±1.41) in theSpA group and in HC group respectively (P<0.001). The ROC area under thecurve increased to0.819(P<0.005) when PDS was added, which achieved asensitivity of70.0%and a specificity of91.7%.（3） TGS was associated with patient global assessment, but they are not associatedwith age, disease duration, BASDAI, BASFI, BASMI, ESR, CRP.Conclusion:（1） Enthesis score may be useful for improving the diagnositic accuracy of SpA.GUESS plus PDS were more sensitive than GUESS alone.（2） The disease condition of SpA patients with peripheral enthesis involvementmight be active, even their BASDAI, levels of ESR, CRP and morning stiffnesstime were under active levels. |
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