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Multicenter Study
. 2025 Oct:74:152823.
doi: 10.1016/j.semarthrit.2025.152823. Epub 2025 Aug 28.

Entheseal structural damage according to OMERACT definitions unveils distinct ultrasound phenotypes in SpA: findings from the DEUS multicentre study

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

Entheseal structural damage according to OMERACT definitions unveils distinct ultrasound phenotypes in SpA: findings from the DEUS multicentre study

Stefano Di Donato et al. Semin Arthritis Rheum. 2025 Oct.
Free article

Abstract

Objectives: To explore the prevalence and distribution of ultrasound-detected lesions indicating structural damage at the enthesis (e.g., bone erosions, enthesophytes, and calcifications) in patients with spondyloarthritis (SpA), comparing those with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), and to investigate the demographic, clinical, and metabolic factors linked to these lesions.

Methods: A cross-sectional analysis was conducted using data from the DEUS study, a multicentre investigation involving 20 rheumatology centres and including 413 patients with SpA (224 with axSpA and 189 with PsA). All participants underwent standardized clinical and ultrasound assessment of the large lower limb entheses (quadriceps tendon, proximal and distal patellar tendons, Achilles tendon, and plantar fascia). Entheseal structural lesions were explored by ultrasound and classified according to OMERACT definitions. Bivariate analyses and multivariate logistic regression were used to assess associations between ultrasound lesions and SpA patients' characteristics.

Results: In SpA patients, enthesophytes were the most common lesion (78.7 %), followed by calcifications (43.6 %) and bone erosions (24.9 %). Enthesophytes were more prevalent in PsA (86.8 %) compared to axSpA (71.9 %) (p < 0.001), with no significant differences in erosions and calcifications. However, lesion distribution varied across different entheses. Multivariate analysis revealed that entheseal erosions were significantly associated with inflammatory markers, HLA-B27 positivity, clinical enthesitis, and longer disease duration. Enthesophytes were significantly linked to PsA, psoriasis, clinical enthesitis, and longer disease duration. Calcifications were positively associated with hypertension, metabolic syndrome, and obesity. All lesions were associated with biologic DMARD use.

Conclusions: This study reveals a high prevalence of ultrasound-detected structural damage at the enthesis and identifies distinct SpA phenotypes based on these findings.

Keywords: Calcifications; Enthesitis; Enthesophytes; Erosions; OMERACT; Structural damage; Ultrasound.

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Conflict of interest statement

Declaration of competing interest EC has received speaking fees from Novartis and IBSA outside the submitted work. He also consulting fees from Horizon Therapeutics and research grants from FOREUM. . JM has received speaking fees from UCB, Galapagos and Novartis, and support for attending meetings or congresses from Novartis and Lilly, outside the submitted work. PE has received speaking fees from Abbvie, Activa, Anatptysbio, Astra-Zeneca, BMS, Boehringer Ingelheim, Galapagos, Gilead, Immunovant, Janssen, Lilly, and Novartis outside the submitted work. He has also received research grant support from Abbvie, BMS, Lilly, Novartis, Pfizer, Samsung outside the submitted work. EF has received speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Novartis, Pfizer, Roche and Union Chimique Belge Pharma outside the submitted work. ADM has received speaking fees from Janssen and Astrazeneca, and research grant support from Alfasigma, outside the submitted work. All other authors have declared no conflict of interest.

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