Abstract
Using clinical and musculoskeletal ultrasonographic (MSUS) examination, we aimed to compare the frequency, pattern, and main sites of peripheral enthesopathies in the lower limbs of ankylosing spondylitis (AS) and Behcet’s disease (BD) patients, and to evaluate their relation with different clinical, laboratory, and functional parameters of both diseases. Fifteen AS patients (group I) and 22 BD patients (group II) were examined clinically and by carrying out MSUS for enthesopathy at five entheseal sites of the lower limbs. A control group of 20 apparently healthy male volunteers was also included. An enthesopathy score was calculated for each patient according to the Glasgow ultrasound enthesitis scoring system (GUESS). Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index and the Behcet’s disease current activity form in both groups, respectively. The GUESS score was significantly higher (P 0.05), disease duration (P > 0.05), spinal pain scores (P > 0.05), local tenderness scores (P > 0.05), morning stiffness score (P > 0.05), total Bath Ankylosing Spondylitis Disease Activity Index (P > 0.05), Bath AS metrology indices (P > 0.05), AS quality of life scores (P > 0.05), radiographic scores (P > 0.05), erythrocyte sedimentation rate (P > 0.05), and C-reactive protein levels (P > 0.05). In group II, the mean GUESS score was significantly higher (P 0.05) with disease activity. Ultrasonographic changes at the entheseal sites of the lower limbs are prevalent in both AS and BD. These changes are more frequently related to functional and articular involvement. MSUS is more sensitive than clinical examination in detecting enthesopathies of the lower limbs in both AS and BD patients.
Highlights
Spondyloarthropathies (SpA) are a family of related disorders characterized by an increased frequency of the HLA-B27 marker, familial aggregation, axial skeleton involvement, and entheseal involvement
It is well known that enthesitis is considered to be the initial site of inflammation in SpA group of diseases, which later extends to the adjacent synovial tissues [6]
We demonstrated that clinically detected enthesitis, especially being tender on palpation, were significantly more frequent in ankylosing spondylitis (AS) patients (28%) than in Behçet’s disease (BD) patients (36%)
Summary
Spondyloarthropathies (SpA) are a family of related disorders characterized by an increased frequency of the HLA-B27 marker, familial aggregation, axial skeleton involvement, and entheseal involvement They mainly include ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated SpA [1,2]. Musculoskeletal involvement in BD is one of the most frequent finding; arthritis and arthralgia are most common, followed by enthesopathy, avascular necrosis, myalgia, and myositis [4].
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