Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy
Open Access
- 1 October 2002
- journal article
- research article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 61 (10), 905-910
- https://doi.org/10.1136/ard.61.10.905
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.This publication has 33 references indexed in Scilit:
- Inflamed retrocalcaneal bursa and Achilles tendonitis in psoriatic arthritis demonstrated by ultrasonographyAnnals Of The Rheumatic Diseases, 2000
- Effects of a loading dose regimen of three infusions of chimeric monoclonal antibody to tumour necrosis factor alpha (infliximab) in spondyloarthropathy: an open pilot studyAnnals Of The Rheumatic Diseases, 2000
- Sonographic analysis of the ankle in patients with psoriatic arthritisScandinavian Journal of Rheumatology, 2000
- Arthritis of the finger joints: A comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imagingArthritis & Rheumatism, 1999
- Classification of inflammatory arthritis by enthesitisThe Lancet, 1998
- The European Spondylarthropathy Study Group Preliminary Criteria for the Classification of SpondylarthropathyArthritis & Rheumatism, 1991
- Discovertebral destruction in ankylosing spondylitis: the role of computed tomography and magnetic resonance imagingThe British Journal of Radiology, 1990
- Measuring disease activity: comparison of joint tenderness, swelling, and ultrasonography in rheumatoid arthritisArthritis & Rheumatism, 1987
- PLANTAR FASCIITIS AND ACHILLES TENDINITIS AMONG 150 CASES OF SERONEGATIVE SPONDARTHRITISRheumatology, 1980
- Enthesopathy of rheumatoid and ankylosing spondylitis.Annals Of The Rheumatic Diseases, 1971