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Multicenter Study
. 2025 Jan;77(1):22-33.
doi: 10.1002/art.42971. Epub 2024 Oct 15.

Relationship Between Ultrasound and Physical Examination in the Assessment of Enthesitis in Patients With Spondyloarthritis: Results From the DEUS Multicenter Study

Andrea Di Matteo  1 , Stefano Di Donato  2 , Gianluca Smerilli  3 , Andrea Becciolini  4 , Federica Camarda  5 , Alberto Cauli  6 , Tomás Cazenave  7 , Edoardo Cipolletta  3 , Davide Corradini  6 , Juan Jose de Agustin  8 , Giulia M Destro Castaniti  5 , Eleonora Di Donato  4 , Emine Duran  9 , Bayram Farisogullari  9 , Marco Fornaro  10 , Francesca Francioso  3 , Pamela Giorgis  7 , Raquel Granados  11 , Amelia Granel  12 , Cristina Hernandez-Diaz  13 , Rudolf Horvath  14 , Jana Hurnakova  14 , Diogo Jesus  15 , Omer Karadag  9 , Ling Li  16 , Yang Li  16 , Maria G Lommano  3 , Josefina Marin  17 , María V Martire  12 , Xabier Michelena  8 , Laura Muntean  18 , Matteo Piga  6 , Marcos Rosemffet  7 , João Rovisco  19 , Fausto Salaffi  3 , Liliana Saraiva  19 , Crescenzio Scioscia  10 , Maria-Magdalena Tamas  18 , Shun Tanimura  20 , Aliki Venetsanopoulou  21 , Lucio Ventura Rios  22 , Orlando Villota  23 , Catalina Villota-Eraso  23 , Paraskevi V Voulgari  21 , Gentiana Vukatana  24 , Johana Zacariaz Hereter  17 , Walter Grassi  3 , Emilio Filippucci  3
Affiliations
Multicenter Study

Relationship Between Ultrasound and Physical Examination in the Assessment of Enthesitis in Patients With Spondyloarthritis: Results From the DEUS Multicenter Study

Andrea Di Matteo et al. Arthritis Rheumatol. 2025 Jan.

Abstract

Objective: The study objectives were (i) to explore the agreement between the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and physical examination in assessing enthesitis in patients with spondyloarthritis (SpA) and (ii) to investigate the prevalence and clinical relevance of subclinical enthesitis in this population.

Methods: Twenty rheumatology centers participated in this cross-sectional study. Patients with SpA, including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), underwent both ultrasound scan and physical examination of large lower limb entheses. The OMERACT ultrasound lesions of enthesitis were considered, along with a recently proposed definition for "active enthesitis" by our group. Subclinical enthesitis was defined as the presence of "active enthesitis" in ≥1 enthesis in patients with SpA without clinical enthesitis (ie, number of positive entheses on physical examination and Leeds Enthesitis Index score = 0).

Results: A total of 4,130 entheses in 413 patients with SpA (224 with axSpA and 189 with PsA) were evaluated through ultrasound and physical examination. Agreement between ultrasound and physical examination ranged from moderate (ie, enthesophytes) to almost perfect (ie, power Doppler and "active enthesitis"). Patellar tendon entheses demonstrated the highest agreement, whereas Achilles tendon insertion showed the lowest. Among 158 (38.3%) of 413 patients with SpA with clinical enthesitis, 108 (68.4%) exhibited no "active enthesitis" on ultrasound. Conversely, of those 255 without clinical enthesitis, 39 (15.3%) showed subclinical enthesitis. Subclinical enthesitis was strongly associated with local structural damage. However, no differences were observed regarding the demographic and clinical profiles of patients with SpA with and without subclinical enthesitis.

Conclusion: Our study underscores the need for a comprehensive tool integrating ultrasound and physical examination for assessing enthesitis in patients with SpA.

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References

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