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The incremental value of ultrasound in detection of subclinical peripheral enthesitis in patients with spondyloarthritis

elMallah R, Abdo M, Mobasher S

The Egyptian Rheumatologist 2020 Oct;42(4):255-260

primary study

INTRODUCTION: Inflammatory enthesitis is a hallmark in spondyloarthritis (SpA). It is detected by clinical examination but lacks sensitivity and reliability. Ultrasonography (US) is more accurate in detecting enthesitis. AIM OF THE WORK: To evaluate the value of US in diagnosis of enthesopathy in SpA and assess its relation compared to clinical assessment. PATIENTS AND METHODS: Thirty-one SpA patients were subjected to history-taking, clinical examination, laboratory investigations, clinical and US assessment of the same entheseal points. RESULT(S): The patients mean age was 41.2 +/- 2.4 years (28 to 68 years); 23 males and 8 females. The mean disease duration was 10.4 +/- 3.3 years (2 months to 20 years). 12 cases had psoriatic arthritis (PsA), 12 ankylosing spondylitis (AS) and 7 had reactive arthritis (ReA). Most commonly affected entheses in lower limbs were Achilles tendons (right 70% and left 80%), while in the upper limbs were supraspinatus tendons (right 65% and left 35%). A significant difference was found between clinical and US examination of enthesitis as 19% of examined entheses were abnormal clinically, while 57% with US. Significant agreement was found between clinical and ultrasound examination in detection of enthesitis at supraspinatus with maximum odd ratios for calcifications 72 and erosions 16. Sensitivity of US was 91.9%, while specificity was 83.7%. CONCLUSION(S): Ultrasonography is superior to clinical examination in detection of enthesitis in SpA patients with good sensitivity and specificity. Enthesitis is common in upper limbs as it is in lower limbs; pathological findings and predictive values of calcifications and erosions were high at entheses of upper limbs especially supraspinatus.

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