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. 2025 Aug 8.
doi: 10.1007/s00393-025-01701-4. Online ahead of print.

A comprehensive evaluation of radiographic trochanteric enthesitis in axial spondyloarthritis : Prevalence, disease activity, and functional impairments

Ezgi Akyıldız Tezcan  1 , Kemal Erol  2
Affiliations

A comprehensive evaluation of radiographic trochanteric enthesitis in axial spondyloarthritis : Prevalence, disease activity, and functional impairments

Ezgi Akyıldız Tezcan et al. Z Rheumatol. .

Abstract
in English, German

Objective: Enthesitis is a hallmark of axial spondyloarthritis (axSpA) with a notable impact on quality of life. However, information on the prevalence, burden of damage, and associated characteristics of trochanteric enthesitis is lacking. This novel study aimed to explore the prevalence of radiographic trochanteric enthesitis in axSpA patients and analyze its association with disease activity and functional impairments in detail.

Methods: This retrospective cross-sectional observational study included 165 patients diagnosed with axSpA who underwent pelvic radiography. Clinical and demographic data were collected, including disease activity scores, functional status, and spinal mobility. Statistical analyses examined associations with trochanteric enthesitis; binary logistic regression identified independent predictors.

Results: Radiographically, trochanteric enthesitis was observed in 19 patients (11.5%), more commonly bilaterally (89.5%) and more prevalently in radiographic axSpA (17.7% vs. 5.8%, p = 0.032). Patients with trochanteric enthesitis had higher inflammatory markers (erythrocyte sedimentation rate [ESR], C‑reactive protein [CRP]; p = 0.034, p = 0.006), disease activity scores (axial spondyloarthritis disease activity score with CRP [ASDAS-CRP], ASDAS-ESR, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]; p = 0.004, p = 0.034, p = 0.032), and impaired spinal mobility (Bath Ankylosing Spondylitis Metrology Index [BASMI], p = 0.014). Functional impairments were observed in lumbar lateral flexion, intermalleolar distance, cervical rotation, and chest expansion (p = 0.048, p = 0.009, p = 0.029, p = 0.029). In binary logistic regression, age (p = 0.015) and CRP (p = 0.011) emerged as independent predictors of radiographic trochanteric enthesitis.

Conclusion: Trochanteric enthesitis affects a notable subset of axSpA patients, especially those who are older and have elevated CRP. It is associated with higher disease activity, increased systemic inflammation, and functional impairment.

Zusammenfassung: ZIELE: Enthesitis ist ein zentrales Merkmal der axialen Spondyloarthritis (axSpA) mit erheblichem Einfluss auf die Lebensqualität. Daten zur trochantären Enthesitis sind jedoch rar. Diese Studie untersuchte die Prävalenz der radiographischen trochantären Enthesitis bei axSpA-Patient:innen sowie deren Zusammenhang mit Krankheitsaktivität und funktionellen Einschränkungen.

Methoden: In eine retrospektive Querschnittstudie wurden 165 axSpA-Patient:innen mit Beckenradiographie eingeschlossen. Klinische und demografische Daten (Krankheitsaktivitätsscores, Funktionsstatus, Wirbelsäulenbeweglichkeit) wurden erhoben. In statistischen Analysen wurde die Assoziation mit trochantärer Enthesitis geprüft; eine binäre logistische Regression identifizierte unabhängige Prädiktoren.

Ergebnisse: Eine trochantäre Enthesitis wurde bei 19 Patient:innen (11,5 %) radiographisch nachgewiesen, überwiegend beidseitig (89,5 %) und häufiger bei radiographischer axSpA (17,7 vs. 5,8 %; p = 0,032). Betroffene wiesen erhöhte Entzündungsmarker (Blutsenkungsgeschwindigkeit, BSG; C‑reaktives Protein, CRP; p = 0,034 bzw. p = 0,006), höhere Krankheitsaktivität (Ankylosing Spondylitis Disease Activity Score mit CRP, ASDAS-CRP; Ankylosing Spondylitis Disease Activity Score mit BSG, ASDAS-ESR; Bath Ankylosing Spondylitis Disease Activity Index, BASDAI; p = 0,004; p = 0,034 bzw. p = 0,032) und eine eingeschränkte Wirbelsäulenbeweglichkeit (Bath Ankylosing Spondylitis Metrology Index, BASMI; p = 0,014) auf. Funktionelle Defizite betrafen die laterale Lendenwirbelsäulenflexion, den Intermalleolarabstand, die Halsrotation und die Brustkorberweiterung (p = 0,048; p = 0,009; p = 0,029; p = 0,029). Alter (p = 0,015) und CRP (p = 0,011) erwiesen sich als unabhängige Prädiktoren.

Schlussfolgerung: Trochantäre Enthesitis betrifft einen beachtlichen Anteil von axSpA-Patient:innen, insbesondere ältere mit erhöhtem CRP, und ist mit höherer Krankheitsaktivität, verstärkter Entzündung sowie funktionellen Einschränkungen verbunden.

Keywords: Extra‑articular manifestations; Hip joint; Inflammation; Mobility limitation; Musculoskeletal diseases.

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Conflict of interest statement

Declarations. Conflict of interest: E.A. Tezcan and K. Erol declare that they have no competing interests. This study was performed in accordance with the ethical standards laid down in the Declaration of Helsinki, and approval was obtained from the institutional ethics committee (Approval number: 2025/50).

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