Abstract
With the increased utilization of musculoskeletal ultrasound in clinical practice, there has been rapid proliferation of publications on sonographic evaluation of enthesitis. This has led to the development of multiple new approaches to scoring sonographic findings in the detection of enthesitis, with variations including entheseal sites and sonographic features that limit cross-study comparisons. Furthermore, despite efforts to standardize the definition of enthesitis, there is still heterogeneity in the sonographic features included in existing ultrasound scores, and additional adjustments are required to distinguish active inflammatory changes from non-inflammatory conditions and to adjust for demographic features associated with increased prevalence of abnormal sonographic findings. This review provides an update on the current landscape of ultrasound scoring systems for enthesitis and emphasizes the importance of future data-based ultrasound scoring systems to improve the distinction between inflammatory and non-inflammatory or degenerative changes of the enthesis.
Highlights
Ultrasound has been increasingly utilized as an imaging modality to improve detection of inflammation of the enthesis, termed enthesitis, and has informed the understanding of associated inflammatory changes that extend to the adjacent fibrocartilage, bone, and, if present, bursa [1,2]
We examine the ultrasound scoring systems for enthesitis published to date and recent findings on the prevalence of non-inflammatory sonographic entheseal abnormalities in order to inform the development of an ultrasound scoring system that improves the distinction of enthesitis from non-inflammatory enthesopathy
In addition to the previously published ultrasound scoring systems included in a previous review [11], an additional 170 publications were initially identified in this literature search, which were analyzed separately from and in addition to a previous systematic review of enthesitis scoring indices [12]
Summary
Ultrasound has been increasingly utilized as an imaging modality to improve detection of inflammation of the enthesis, termed enthesitis, and has informed the understanding of associated inflammatory changes that extend to the adjacent fibrocartilage, bone, and, if present, bursa [1,2]. Detection of entheseal vascularization by power Doppler (PD) has been demonstrated to have a role in identifying early cases of spondyloarthritis [3]. This imaging modality has been shown to improve detection of enthesitis in patients with other chronic conditions that are not traditionally considered inflammatory, such as fibromyalgia, which can present with similar pain at entheseal sites and may at times be difficult to distinguish clinically [4,5]. Ultrasound scoring systems or indices, defined as summative measures of sonographic abnormalities at specified entheseal sites, have previously been used as indicators of the sonographic detection of enthesitis [2,3,4]. Not all of these characteristic features of enthesitis have been uniformly included in the available ultrasound scoring indices
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