Abstract
Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.
Highlights
Detection of enthesopathy includes clinical exam and imaging
Madrid Sonography Enthesitis Index (MASEI) = Madrid Sonography EninthcelusidtiesdInidnext,hSiEs Ir=evSipeawni.shEvEanltuheastiitoisnInodfetxh.e primary scoring index used in these studies revealed that MASEI was used in 9 studies, Glasgow Ultrasound Enthesitis Scoring System (GUESS) was used in 2 studies, the D’Agostino
Our study found features of enthesophytes, tendon tearing, and tendon hypertrophy included in enthesitis scoring, despite their presence in non-inflammatory conditions
Summary
Detection of enthesopathy includes clinical exam and imaging. Ultrasound (US)is one of the more popular imaging modalities that has demonstrated high sensitivity and lower costs in use of detection of enthesopathy [1,2,3,4,5,6]. Detection of enthesopathy includes clinical exam and imaging. Is one of the more popular imaging modalities that has demonstrated high sensitivity and lower costs in use of detection of enthesopathy [1,2,3,4,5,6]. US can be performed at the bedside, is fast, reproducible, and preferred among many practitioners [2,3,4,5,7,8,9]. US can demonstrate features of enthesitis including tendon thickening, enthesophytes, bursitis and erosions [8]. US can show discontinuity of tendon fibers, focal hypoechoic intratendinous areas, and fluid around the tendon [9]. More specific features within the enthesitis definition including power Doppler signal and hypervascularity are identified with ultrasound
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