Enthesopathy In Patients Research Articles

Enthesopathy in patients with nail psoriasis - a cross-sectional evaluation of clinical, onychoscopic and ultrasonographic features.

Background Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic features in patients with nail psoriasis. Materials and Methods All nails of twenty adult patients with nail psoriasis were examined clinically and onychoscopically. Patients were evaluated for psoriatic arthritis (Classification Criteria for Psoriatic Arthritis), the severity of cutaneous disease (Psoriasis Area Severity Index) and nail disease (Nail Psoriasis Severity Index). Ultrasonography of the clinically involved digits was performed for evidence of distal interphalangeal joint enthesitis. Results Out of 20 patients, 18 patients had cutaneous psoriasis and 2 had isolated nail involvement. Among the 18 patients with skin psoriasis, 4 had associated psoriatic arthritis. The most commonly observed clinical and onychoscopic features were pitting (31.2% and 42.2%), onycholysis (36% and 36.5%) and subungual hyperkeratosis (30.2% and 30.5%), respectively. Ultrasonographic evidence of distal interphalangeal joint enthesitis was seen in 57% (175/307) of the digits with clinical nail involvement. Enthesitis was more common in patients with psoriatic arthritis (77% vs 50.6%). Nail thickening, crumbling and onychorrhexis (all features of nail matrix involvement) were significantly associated with enthesitis (P < 0.005). Limitation The major limitation was the small sample size and lack of controls. Only the clinically involved digits were evaluated for enthesitis. Conclusion Enthesitis was frequently detected on ultrasonography in patients with nail psoriasis, even in clinically asymptomatic individuals. Nail features of thickening, crumbling and onychorrhexis may predict underlying enthesitis and the potential development of arthritis. A comprehensive evaluation could help identify patients with psoriasis at risk for arthritis, helping improve long-term outcomes.

Sonographic evaluation of subclinical entheseal involvement in patients with hypoparathyroidism: a case control study.

Hypoparathyroidism is a disease characterized by low serum calcium, increased serum phosphorus and low PTH levels. Although patients are treated with active vitamin D and calcium, a proper serum calcium phosphorus balance cannot always be achieved. Ectopic calcifications that develop in organs during treatment are the most common complications. To date, there is not any published study on enthesopathy in patients with hypoparathyroidism. The aim of this study was to evaluate subclinical enthesopathy in patients with hypoparathyroidism with ultrasound and to compare the results with those of the control group. The study included patients aged 18-65years with postoperative hypoparathyroidism and hypothyroidism (group hypoP + hypoT), patients with postoperative hypothyroidism (group hypoT), and healthy age and sex-matched volunteers (group C). Ultrasonographic findings of enthesopathy in both extremities were documented according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). GUESS scores in group hypoP + hypoT, were significantly higher when compared to the other groups. There was a statistically significant correlation between the total GUESS scores and total enthesophyte scores and the duration of hypoparathyroidism (p < 0.05, r = 0.43) (p < 0.05, r = 0.39) respectively. In the correlation analysis of all groups, a significant negative correlation was found between serum Ca and PTH levels and the total GUESS scores (p < 0.01, r = -0.37; p < 0.01, r = -0.54, respectively). This study showed that GUESS scores were significantly higher in patients with hypoparathyroidism compared to those with hypothyroidism and control subjects. GUESS scores were positively correlated with disease duration. Patients with hypoparathyroidism need to be evaluated for subclinical enthesopathy during follow-up.

Radiographic Ischial Enthesopathy in Patients with Psoriatic Arthritis

AbstractBackground To investigate the prevalence of radiographic ischial entheseal lesions in patients with psoriatic arthritis (PsA) compared to patients with rheumatoid arthritis (RA).Patients and Methods Thirty-eight patients with PsA and 46 patients with RA were included. Anteroposterior radiographs of the pelvis and lateral foot were evaluated for entheseal lesions. The following entheseal sites were reviewed: os ischium, bilateral Achilles tendon and inferior calcaneus. Abnormalities such as cortical erosions and enthesophytes (irregular bony proliferation) were recorded.Results The frequency of enthesopathic changes in the ischial region was found to be statistically significantly higher in PsA patients compared with RA patients (50 and 28.3%, respectively, p=0.04). Enthesopathic changes of the calcaneus and Achilles tendon also occurred more frequently in PsA patients than in RA patients.Conclusion Radiographic entheseal lesions in the ischial region are more prevalent in PsA patients compared with RA patients with symptoms in that region. Furthermore, such enthesopathic changes in the ischium are observed as frequently as changes in the Achilles tendon. These findings regarding structural entheseal lesions in the pelvic region contribute to the knowledge of entheseal involvement in PsA.

Клинико-ультразвуковые характеристики поражения энтезисов при воспалительных заболеваниях кишечника

Aim: to assess enthesis lesions in patients with inflammatory bowel disease/IBD (ulcerative colitis/UC and Crohn’s disease/CD) and associations between the clinical pattern of the underlying disease and enthesopathy verified by ultrasound. Patients and Methods: this study included 95 patients with IBD aged 26–37 (the mean age was 37 years). Each patient underwent clinical examination and ultrasound of the entheses of the upper and lower extremities with calculating enthesial indices. The pattern of enthesopathy in patients with UC and CD was compared. Correlations between clinical characteristics of IBD and enthesopathy were evaluated. The analysis of individual anatomical sites of tendon and ligament insertions in patients with IBD was performed for the first time. Results: pain elicited on local pressure of entheseal points was seen in 52%. Enthesitis was diagnosed through ultrasound in 76% of patients (enthesitis with vascularization in 76%, erosions at insertions in 80%, and enthesophytes in 39%). When assessing anatomical sites, the most common impairment was a medial collateral ligament lesion, while the most common localization of enthesophytes was the insertion point of the quadriceps femoris muscle. Disease duration directly correlated to the number of painful entheses on palpation (SR=0.24, р=0.017) and the number of enthesophytes (SR=0.20, р=0.044). We failed to identify any significant associations between the severity of the attack and enthesis lesions in UC and CD. Direct correlations between the number of extraintestinal manifestations and the number of painful entheses on palpation (SR=0.35, р=0.0004) and LEI (SR=0.2, р=0.04) and GUESS scores (SR=0.28, р=0.004); the number of erosions with vascularization and ESR (SR=0.26, р=0.01) and CRP (SR=0.25, р=0.01); the number of painful entheses on palpation and the number of enthesitis (SR=0.71, р=0.00) including those with vascularization (SR=0.27, р=0.00) were revealed. Conclusion: enthesopathy is a common extraintestinal manifestation of IBD independent of a nosology of the severity of the attack of the underlying disease. Greater disease duration, pain at entheses on palpation, and increased inflammatory markers (ESR, CRP) are associated with enthesis lesions. Therefore, current enthesopathy indices can be applied to assess and monitor entheses. KEYWORDS: inflammatory bowel disease, ultrasound, enthesitis, vascularization, Power Doppler imaging, enthesopathy scores. FOR CITATION: Gainullina G.R., Kirillova E.R., Odintsova A.Kh., Abdulganieva D.I. Clinical and sonographic characteristics of enthesis lesions in inflammatory bowel disease. Russian Medical Inquiry. 2021;5(6):385–390 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-385-390.

Sonographic Evaluation of Subclinical Enthesopathy in Patients of Chronic Plaque Psoriasis.

Background:Psoriasis is associated with spondyloarthropathy in 10%–30% of cases. Enthesitis is major feature of psoriatic arthritis. Ultrasonography can detect subclinical entheseal abnormalities in psoriasis patients.Objectives:To determine the prevalence of subclinical enthesopathy in psoriasis vulgaris using ultrasonography and evaluating its correlation with severity and duration of psoriasis.Materials and Methods:This study included 50 patients of psoriasis vulgaris and 50 healthy controls. Sonographic evaluation of six sites bilaterally (proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligaments, distal quadriceps, and brachial triceps tendons) were done in each subject. All Ultrasonographic findings were identified according to MASEI (Madrid sonography enthesitis index). Enthesopathy scores of patients and controls were compared and receiver operating characteristic curve was used to determine cut off value of MASEI, above which ultrasound enthesitis of clinical significance could be diagnosed.Results:31 (62%) psoriasis patients had subclinical enthesopathy of clinical significance as compared to only 5 (10%) of controls. Mean MASEI score between psoriasis cases and control was statistically different, 12.72 ± 7.55 (Mean ± SD) and (5.14 ± 4.69), respectively (P value 0.000001).The receiver operating characteristic curve established an ultrasound score of >11 as the best cut-off to differentiate between subject with enthesopathy of clinical significance from those with enthesopathy of unknown significance. No statistically significant correlation was found between the degree of enthesopathy (MASEI score) and duration and severity of the psoriasis.Conclusion:Ultrasonography can effectively screen subclinical entheseal abnormalities in psoriasis patients.

Sonographic evaluation of enthesopathy in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is one of the most common autoimmune diseases. It affects mainly the synovial membranes of the small joints. However, it may also have extra-articular manifestations. Enthesopathy may occur as one of the extra-articular manifestations of RA and is not clinically detected. Ultrasound (US) is a relatively new tool for the detection of enthesopathy.AimThe aim of this study was to assess the presence and distribution of enthesopathy in RA patients using US.Patients and methodsTwenty-nine consecutive patients with RA and 14 age-matched healthy controls were included in this study. All RA patients met the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. Six entheses sites were evaluated using gray scale and Doppler US with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI).ResultsUS detected the presence of enthesopathy in patients with RA. There was a statistically significant difference in the enthesopathy score of plantar aponeurosis insertion and Achilles tendon insertion. The total enthesopathy score was statistically significant in patients with RA versus controls.ConclusionUS entheseal abnormalities are present in a high percentage of RA patients. US enthesopathy is not associated with disease activity in RA patients.

Power Doppler Ultrasonography on Tendons of Lower Limbs to Assess Subclinical Enthesopathy in Patients with Psoriasis: A Cross-Sectional Study

Background: Psoriatic arthritis is a long-term condition that affects some people who have psoriasis. In severe cases, there's a risk of the joints becoming permanently damaged or deformed. Diagnosis of psoriasis-associated enthesopathy helps early detection and treatment of psoriatic arthropathy before joint damage becomes established. Objective: to detect the presence of asymptomatic entheseal abnormalities in psoriatic patients in an attempt for preclinical detection of psoriatic arthritis before full joint affection becomes established. Methods: A cross-sectional study included 50 with psoriasis without evidence of arthropathy collected from Ain Shams University hospitals. All the patients were subjected to the following: Full history, clinical examination, routine laboratory investigations and power doppler US on both lower limb entheses. Results: The present study proved that 48 patients out of 50 with psoriasis showed entheseal abnormalities at least in one site of lower limbs detected by MSUS and this was assessed using glascow ultrasound enthesopathy scoring system (GUESS). Conclusion: MSUS is useful in the detection of early findings of psoriatic arthropathy especially the presence of enthesitis even in asymptomatic patients.

Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis

The aim of the study was an ultrasound assessment of distal interphalangeal (DIP) joint enthesopathy in patients with nail psoriasis. Altogether, 72 patients with nail psoriasis (41 with psoriasis and 31 with psoriatic arthritis) and 30 people in the control group participated in the study. In total, 1014 nails were examined. The thickness of DIP digital extensor tendons in the groups of patients with psoriasis (Ps) and psoriatic arthritis (PsA) was correlated with the nail bed thickness (r = 0.316, p = 0.027 vs. r = 0.402, p = 0.031, respectively) and with the thickness of the nail matrix in patients with psoriasis (r = 0.421, p = 0.012). The linear regression model showed the tendon thickness in Ps patients to be affected by the nail bed thickness, duration of psoriasis and the thickness of the nail matrix, whereas in PsA patients it was found to be significantly affected by duration of psoriasis and of arthritis, the nail bed thickness, CRP concentration and the swollen joint count. Our findings may indicate the role of the nail-tendon apparatus changes in the PsA development and they emphasise the justifiability of US examinations in patients with psoriasis direct assessment of morphological changes in nails as potential predictors of PsA development.

Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis.

To assess the effect of methotrexate on the development of distal interphalangeal joint extensor tendon enthesopathy in psoriasis, thirty-two people aged 34 to 57 years with nail psoriasis and distal interphalangeal joint extensor tendon enthesopathy (19 patients with Ps (psoriasis) and 13 with PsA (psoriatic arthritis) were started on methotrexate at 15 to 25 mg/week and the treatment was continued for 6 months). A total of 319 nails were examined. After six months of treatment, the thicknesses of the nail plate, nail bed and nail matrix were found to decrease in both groups of patients. Methotrexate treatment resulted in a decrease in the joint extensor tendon thickness only in patients with Ps (0.94 ± 0.05 vs. 0.96 ± 0.04, p < 0.001), where the tendon thickness after treatment correlated with the matrix thickness (r = 0.337, p = 0.018) and with the bed thickness (r = 0.299, p = 0.039). Methotrexate treatment resulted in a decrease in the extensor tendon thickness only in patients with Ps but not in PsA. The findings of this study may suggest the effectiveness of systemic treatment of nail psoriasis in patients without arthritis and the use of US nail examinations in Ps and PsA patients in morphological change assessment and response to treatment.

Subclinical enthesopathy of extensor digitorum tendon is highly prevalent and associated with clinical and ultrasound alterations of the adjacent fingernails in patients with psoriatic disease.

Nail psoriasis disease is associated with an increased probability of psoriatic arthritis, and its clinical signs may have different correlates with the pathogenesis of adjacent bone destruction and have different prognostic value. Recent publications about psoriasis and nail psoriatic disease describe different ultrasonographic findings but the relationship between these ungueal alterations measured by ultrasonography and the presence of enthesopathy of the extensor digitorum has yet to be discovered. To describe which ultrasonographic characteristics of nail psoriasis are associated with the presence of subclinical enthesopathy in patients with PsO and asymptomatic PsA. Patients with psoriasis and asymptomatic psoriatic arthritis were included in the prospective study. Demographic, clinical data and PASI and NAPSI indexes were recorded of all the patients in the assessment visit. The US assessment included Achilles tendon, extensor digitorum tendon and US scan of the nail plate, nail matrix, nail bed and adjacent skin over nail matrix of the five nails of each hand. Forty-eight patients were included in the study; 33 of them presented ultrasound evidence of extensor digitorum tendon enthesopathy. Nails of the patients with subclinical enthesopathy had a higher NAPSI and skin thickness than the nails of the patients without subclinical enthesopathy (P = 0.047). Patients with asymptomatic enthesopathy had significantly thicker proximal nail folds (1.44 ± 0.312 vs. 1.23 ± 0.27, P = 0.023). Nail beds and matrices were also thicker but the differences were not statistically significant (1.77 ± 0.27 vs. 1.74 ± 0.21, P = 0.66, and 1.79 ± 0.28 vs. 1.67 ± 0.19, P = 0.10, respectively). No statistically significant differences in the trilaminar structure were found between both groups. Patients with and without asymptomatic enthesopathy of extensor digitorum tendons did not statistically differ as regards ultrasonographic alterations of the Achilles tendons (60.6% vs. 46.4%, P 0.368). Enthesopathy abnormalities can be detected by US in patients with psoriasis without musculoskeletal complaints frequently. There is a close relationship between subclinical enthesopathy of the extensor digitorum tendon and the presence of nail alterations. Further studies are required to research what implications have the presence of these ungual alterations measured by US, and how it affects later development of a PsA.

Association of femoroacetabular impingement and adductor enthesopathy; prevalence and outcomes

Introduction The painful groin is a challenging entity. The complexity of groin anatomy, the similarity of symptoms for different pathologies that may coexist may lead to a diagnostic dilemma and to delays in treatment. The purpose of the study is to assess the prevalence of symptoms consistent with adductor enthesopathy in patients require arthroscopic surgery for treatment of femoroacetabular impingement (FAI) and to evaluate the results of surgical treatment for both of these disorders. Methods Prospectively collected data were retrieved to identify patients with both symptomatic FAI and adductor enthesopathy at the time of presentation. Demographics, clinical examination, imaging signs of hip impingement and adductor enthesopathy were recorded. Isometric strength testing of the adductors and abductors was measured in both legs using a handheld dynamometer. Patients completed the modified Harris hip score (MHHS) pre and postoperatively and pain was evaluated on a visual analog scale. Results From our database of 1135 patients were included 38 (3.34%) patients (44 hips). There were 31 males and 7 females with a mean age 36.8 years (20–63, SD 11.6). Mean follow-up was 27.7 months (SD 19.7). Pubic cleft injections were carried out in 37 (84.09%) hips and 20 (45.4%) hips underwent selective partial adductor release. All of the patients (100%) underwent hip arthroscopic surgery for FAI. Maximum improvement in strength was observed at two months postoperatively both on the operated and non-operated side compared to preoperative strength. The MHHS improved from mean 60 (21–74, SD 16.2) preoperatively to 79 (30–100, SD 17.6) postoperatively and VAS for pain from 6.9 (SD 1.7) to 2.8 (SD 2.6). Conclusion When FAI and adductor enthesopathy are present then both pathologies should be addressed simultaneously or in a staged manner to optimize the postoperative outcomes. Pubic cleft injections and selective partial adductor release are valuable therapeutic procedures in patients treated for symptomatic FAI.

Clinical and ultrasonographic enthesopathy in inflammatory rheumatic diseases : Is MASEI or only calcaneal enthesitis sufficient?

We aimed at investigating the ultrasonographic (US) and clinical prevalence of enthesopathy in patients with rheumatoid arthritis (RA), and axial spondyloarthropathy (SpA), as well as the correlation between this condition and disease activity, along with the quality of life. Included in the study were 30axial SpA, 21patients with RA, and 25healthy cases. Bath Anklylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Quality of Life (ASQoL), Disease activity index 28 (DAS28), and Health Assessment Questionnaire (HAQ) were used for clinical evaluation, and enthesal pain was evaluated by VAS, whereas enthesitis US evaluation was performed by using the MAdrid Sonographic Enthesitis Index (MASEI). Atotal of 152 knees, ankles, and elbow regions of all patients and controls were examined by US. Total scores of physical examination of enthesitis were 1.97± 2.68 in axial SpA, 2.43± 1.80 in RA, and 0.23± 0.12 in the control groups. No statistically significant difference was identified in the enthesitis examination between axial SpA and RA groups (p= 0.123). According to the MASEI, no significant difference was observed in quadriceps tendon enthesitis or in distal patellar ligament enthesitis between axial SpA and RA groups (MASEI3,4,5: p= 0.993, p= 0.124, p= 0.652). Aside from those points, axial SpA patients had statistically higher enthesitis scores at all MASEI enthesitis points (p< 0.05). In the axial SpA group, asignificant and positive correlation was identified between BASDAI scores and total scores of enthesitis physical examination and MASEI total scores (r= 0.739, p= 0.0001, r= 0.516, p= 0.002). Amoderately significant correlation was identified between ASQoL total scores and MASEI total scores (r= 0.466, p= 0.006), but not between the HAQ total scores and MASEI total scores (r= 0.213, p= 0.065). Compared to RA, US and clinical examination of enthesitis in patients with axial SpA should focus on the calcaneal enthesitis region. In axial SpA, ultrasonographic enthesitis is associated with impaired quality of life.

Presence of enthesopathy in patients with primary Sjogren's syndrome: ultrasonographic study of a local cohort.

Musculoskeletal findings in Sjögren's syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases characterized by arthritis. In this study, we aimed to determine the presence of enthesopathy using the Madrid sonographic enthesitis index (MASEI) in patients with primary Sjögren's syndrome (PSS). Consecutive patients with PSS and age-matched healthy controls were included in this study. All the patients met the 2002 American College of Rheumatology/European League against Rheumatism classification criteria for PSS. The demographic characteristics of the patients were recorded. Six enthesis sites were evaluated using gray-scale and Doppler US with a linear transducer, and they were scored using the MASEI. They were assessed by the EULAR Sjögren's syndrome disease activity index (ESSDAI). We evaluated 40 patients with PSS (average age 48.67±11.23years) and 30 healthy controls (average age 45.40±8.24years). Patients with PSS had significantly higher MASEI scores than the healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendons were significantly thicker in the PSS group than in the healthy controls. The MASEI total score had a positive correlation with age. There was no correlation between MASEI total score and BMI and ESSDAI. In this study, it was shown that the MASEI scores assessed by US were significantly higher in patients with PSS than in healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendon were significantly thicker in the PSS group than in the healthy controls. This result suggests that PSS may be one of the causes of musculoskeletal pain that can be seen in patients with PSS. Our study was the first study to use an enthesis index ultrasonographically in patients with PSS. In addition, it is the first study to investigate the relationship between the presence of enthesopathy and disease activity by means of US.

Subclinical enthesopathy in patients with psoriasis and its association with other disease parameters: a power Doppler ultrasonographic study.

This study aimed to determine the prevalence of subclinical enthesopathy in patients with psoriasis using power Doppler ultrasonography (PDUS) and its association with other disease parameters. A total of 50 patients with psoriasis (31 females) aged 19-70 years underwent a thorough clinical examination that included assessment of body mass index (BMI) and psoriasis area and severity index (PASI) score. Measurements of inflammatory markers, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid, and plain radiography of the heels, knees, and sacroiliac joints were performed for all patients. Patients without clinical evidence of arthritis or enthesitis underwent an ultrasonographic (US) examination. According to the US examination, patients were classified into group I (patients with enthesitis) and group II (patients without enthesitis). In group I, Achilles enthesis was the most common site of US enthesitis (33.3%), followed by distal patellar enthesis (22.2%), proximal patellar enthesis (16.7%), quadriceps enthesis (16.7%), and plantar aponeurosis enthesis (11.1%). There was a statistically significant positive correlation between the occurrence of enthesitis and the patient's age, disease duration, PASI score, BMI, and hyperuricemia (p<0.05 for each). In contrast, there was no significant correlation between enthesitis and sex or radiographic sacroiliitis (p>0.05 for each). In addition to the importance of PDUS as a complimentary tool for examining enthesis in patients with psoriasis, the presence of high PASI score, increased BMI and hyperuricemia, and a long disease duration can be considered as predictive parameters for the presence of psoriatic enthesitis.

Nail involvement can predict enthesopathy in patients with psoriasis.

Although subclinical enthesopathy is a well-established diagnostic criterion for psoriatic arthritis (PsA), it is frequently overlooked, as many patients are asymptomatic. The possibility of finding a clinical clue predicting enthesopathy would help clinicians establish an early diagnosis of PsA. A prospective single-center study of a total of 90 patients with psoriasis was conducted to assess the presence of entheseal abnormalities as detected by ultrasound, and to determine any correlation with nail involvement. Entheseal abnormalities were found in 23 patients (25.5%), 19 (82.6%) of whom showed nail involvement, whereas four (17.4%) individuals did not. Enthesopathy was present in 31.1% (19/61) of patients with onychopathy compared to 13.8% (4/29) of those without nail involvement (p = 0.07). There was a significant correlation between target NAPSI score and evidence of enthesopathy. In addition, the number of nails affected also showed a significant correlation with the presence of enthesopathy (p = 0.035). Clinical evidence of onychopathy may be the clue to an early diagnosis of enthesopathy in psoriasis patients.

Presence of enthesopathy demonstrated with ultrasonography in systemic sclerosis

Objective. The aim of this study was to sonographically assess the presence and distribution of enthesopathy in systemic sclerosis (SSc).Methods. Consecutive patients with SSc and age-matched healthy controls were included in this study. All of the patients met the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc. Six entheses sites were evaluated using gray scale and Doppler ultrasonographies (USs) with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI).Results. We evaluated 52 patients with SSc (46.10 ± 13.42 years) and 41 healthy controls (49.59 ± 9.35 years). Patients with SSc had significantly higher MASEI scores than the healthy controls. Except for plantar aponeurosis, the tendons and ligaments were thicker in the SSc group. In the SSc group, there were 25 (48.1%) diffuse cutaneous SScs and 22 (42.3%) limited cutaneous SScs. Variables such as age, BMI, disease duration, diagnostic delay and MASEI scores were similar in subgroups of SSc. There was a positive correlation between MASEI score and age, modified Rodnan's skin score and dyspnea grade, and a negative correlation with handgrip strength.Conclusion. To the best of our knowledge, this is the first study showing the presence of enthesopathy in patients with SSc using US. Enthesopathy should be kept in mind in symptomatic patients with SSc; additionally, it can be easily identified with US.

AB0942 Comparison between Enthesopathy in Psoriasis and Psoriatic Arthritis. (Clinical and Ultrasonographic Study)

BackgroundMany studies revealed subclinical enthesitis in psoriasis patients without any rheumatic complain. Most of these studies utilize diagnostic high frequency ultrasound (US) in detection of abnormal changes at the enthesis1,2....

Assessment of enthesopathy in patients with fibromyalgia by using new sonographic enthesitis index

ObjectiveThe aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). MethodsThis study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Student's t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P<0.05 were considered significant. ResultsTotal enthesitis score was 7.39±4.99 (mean±SD) among FM patients and 3.7±3.22 among healthy controls (P<0.001). The receiver operating characteristic curve established an ultrasound score of > 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. ConclusionsMisdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

THU0380 Enthesopathy in patients with familial mediterranean fever and its association with MEFV gene M694V variant

BackgroundEnthesopathy is the pathologic alteration of bony insertions of tendons, ligaments or joint capsules.1 Enthesopathy is hallmark of spondyloarthropathies and has been reported in various disorders, like Behçet’s disease. Enthesopathy...

Increased Enthesopathy in Patients With Familial Mediterranean Fever

The aim of this study was to determine the frequency of enthesopathy in familial Mediterranean fever by using a newly developed sonographic method, the Madrid Sonographic Enthesitis Index (MASEI). The study included 50 consecutive patients with familial Mediterranean fever and 57 healthy sex- and age-matched control participants. Six entheseal sites (olecranon tuberosity, superior and inferior poles of the patella, tibial tuberosity, and superior and inferior poles of the calcaneus) on both lower limbs were evaluated. All sonographic findings were identified according to MASEI. Validity was analyzed by receiver operating characteristic curves. P < .05 was considered significant. Mean total enthesitis scores ± SD were 7.54 ± 4.99 for patients and 3.63 ± 3.03 for controls (P < .001). No statistically significant correlation was found between the MASEI score and familial Mediterranean fever duration or colchicine treatment duration. There was no difference between the MASEI score and the presence or absence of arthritic involvement among the patients. The area under the receiver operating characteristic curve was 0.74 (95% confidence interval, 0.649-0.839). When analyzed by sex, men with familial Mediterranean fever had significantly higher MASEI scores than women (P < .05). This study showed significant enthesopathy in patients with familial Mediterranean fever. The findings support the hypothesis that familial Mediterranean fever and spondyloarthropathy may have common inflammatory mechanisms and suggest that the MASEI scoring system can be incorporated into clinical protocols for studying patients with familial Mediterranean fever in daily practice.