Glasgow Ultrasound Enthesitis Scoring System Score Research Articles

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.

Clinical joints manifestations in patients with psoriatic arthritis on musculoskeletal ultrasound

To investigate the clinical joints manifestations under musculoskeletal ultrasound (MSUS) and hematological findings in patients with psoriatic arthritis (PsA), which may provide a basis for improving the early diagnosis of PsA. From September 2016 to February 2021, 328 patients with psoriasis visited the dermatological and rheumatic outpatient of the Beijing Friendship Hospital were enrolled in this retrospective study. Patients were enrolled according to a paired-design method. The PsA group included 164 patients diagnosed with PsA, and the control group included 164 patients diagnosed with psoriasis without PsA. Both groups of patients were evaluated by a rheumatoid immunologist, a dermatologist, and a sonographer. Demographic data, course of disease, severity of skin lesions, combined diseases, and previous treatment were all collected. All patients received MSUS and blood examinations. Lower extremity enthsis diseases were evaluated by Glasgow ultrasound enthesitis scoring system (GUESS). In the comparison of baseline clinical characteristics, the PsA group has longer course of psoriasis (P = 0.005), longer course of joints pain (P = 0.035), higher incidence of peripheral joints pain (P = 0.001), higher GUESS score (P < 0.001), and higher incidence of involved nails or toenails (P = 0.036) The most common joints involved were proximal interphalangeal joint (33.5%), knee (27.4%), and metacarpophalangeal joint (25.0%). Differences in clinical manifestations at different lower limb enthesitis on MSUS have also been proved. The positive incidences of rheumatoid factor (RF) (P = 0.002) and anti-cyclic citrullinated peptide (CCP) antibody (P < 0.001) in the PsA group were significantly higher than those in the control group. Binary Logistic regression showed that patients with anti-CCP antibody positive had a higher risk of active PsA compared to patients with negative antibodies in PsA group (OR: 0.626, 95%CI: 0.361-0.792, P < 0.05). In conclusion, the most common joints involved were proximal interphalangeal joint, knee, and metacarpophalangeal joint in patients with PsA, and the common types of diseased joints manifestations on MSUS were synovial thickening, fluid accumulation, bone destruction, increased blood flow signals, and attachment site inflammation. GUESS scoring systems can be used to identify PsA in patients with psoriasis. Psoriasis patients with RF and anti-CCP antibody positive were more likely to develop PsA, and anti-CCP antibody positive was a risk factor for active PsA. • GUESS scoring systems can be used to identify PsA in patients with psoriasis. • Psoriasis patients with RF and anti-CCP antibody positive were more likely to develop PsA, and anti-CCP antibody positive was a risk factor for active PsA.

Subclinical entheseal involvement in patients with rheumatoid arthritis

BackgroundEnthesopathy is a common feature of Spondyloarthritis (SpA) but can also be found in rheumatoid Arthritis (RA). Recognizing enthesopathy could be challenging because of low sensitivity and specific clinical testing. To detect enthesopathy, The European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US). Aim of the workTo investigate the frequency and distribution of entheseal involvement in RA patients and its relation to disease activity. Patients and methods100 RA patients with any symptom in foot and ankle were enrolled. Disease activity score (DAS28), Visual analogue scale (VAS), Health assessment questionnaire-Disability index (HAQ-DI) and Glasgow Ultrasound Enthesitis Scoring System (GUESS) were assessed. ResultsThe mean age of patients was 44.1 ± 12.2 years, disease duration was 7 ± 5.8 years and 86% were females. The mean DAS28 score was 4.3 ± 1.2 and GUESS score was 7.2 ± 4.2; all patients had variable degrees of enthesitis: 30% of patients had mild enthesitis, 42% had moderate enthesitis and 28% had marked enthesitis. GUESS was significantly higher in patients with moderate (7.8 ± 4.9) and high (7.2 ± 3.2) disease activity than in patients with low disease activity (5.2 ± 3.9) and those in remission (6.5 ± 1.9) (p = 0.015). HAQ, Age and ESR significantly correlated with GUESS score (r = 0.19, p = 0.049; r = 0.23, p = 0.023; r = 0.33, p = 0.001 respectively). ConclusionSubclinical enthesitis is remarkable in RA patients. Quadriceps tendon enthesis was mostly affected. Enthesitis is significantly related to age, ESR and HAQ. The presence of enthesitis in RA may represent a potential marker for disease activity.

Lower limb entheseal involvement in systemic lupus erythematosus patients: Relation to disease activity

BackgroundMusculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Musculoskeletal ultrasound (MSUS) is an important tool for evaluation of patients with inflammatory arthritis as well as early detection of subclinical inflammation at the joint, tendon and entheseal level. Aim of the workTo investigate the frequency and distribution of lower limb entheseal abnormalities detected by MSUS in SLE patients and to evaluate its relation to disease activity. Patients and methods50 adult SLE patients were studied. SLE Disease Activity Index-2000 (SLEDAI-2K) was assessed. High-resolution MSUS assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses was performed. Glasgow Ultrasound Enthesitis Scoring System (GUESS) was assessed. ResultsThe median age of the patients was 30 (interquartile range 23–36.3 years) and were 49 females. The median disease duration was 4 (2–8.3 years), SLEDAI-2K was 4 (2–8) and GUESS score 3 (1–5.3). Clinical enthesitis was found in 22 (44%) patients; 58% of the patients had evident MSUS features of enthesitis and 32% had minimal or isolated entheseal abnormalities. The age and SLEDAI-2K were significantly increased in those with clinical enthesitis compared to those without (p = 0.007 and p = 0.03 respectively). GUESS significantly correlated with the age (r = 0.39, p = 0.005) and SLEDAI-2K (r = 0.29, p = 0.04). ConclusionClinical and ultrasound-proved enthesitis are prevalent in SLE patients. Quadriceps tendon insertion is the most affected enthesis. Clinical enthesitis tends to occur in older SLE patients. Enthesitis has positive correlations with; age, and SLEDAI-2K score. The presence of enthesitis may represent a potential marker for SLE disease activity.

Clinical evaluation of foot disability in patients with axial spondyloarthritis

Objective: To evaluate foot disability both ultrasonographically and by using the Foot Function Index (FFI) in patients with axial spondyloarthritis (SpA) and to investigate its effects on patients' quality of life and functional capacity by determining the factors that may affect the level of disability.Patients and methods. A total of 100 patients were included in the study. Enthesis sites in the feet were assessed for tenderness and swelling. Ultrasonographic examination of the Achilles tendon and plantar fascia was made and the findings were scored according to Glasgow Ultrasound Enthesitis Scoring System (GUESS). The Foot Function Index (FFI) was used to investigate the effects of foot disorders on disability and activity limitation. The correlation between GUESS and FFI scores, and relationship of GUESS and FFI scores with age, disease duration, body mass index (BMI), smoking and disease activity parameters were investigated.Results and discussion. Physical examination revealed signs of enthesitis in 13 (13%) patients, while ultrasonographic (USG) evaluation – in 36 (36%) patients. A statistically significant correlation was found between all FFI and GUESS scores except between FFI for the right foot and GUESS for right Achilles tendon enthesitis. A positive correlation was found between age and BMI and FFI (p&lt;0.05). There was no correlation between disease duration and smoking and FFI scores. While there was a statistically significant correlation between all scores of GUESS and age, disease duration, and BMI, no correlation was found between smoking and GUESS scores. No significant difference was found in either FFI or GUESS scores between patients with or without / diabetes and patients who were smokers or non-smokers. All FFI and GUESS scores significantly correlated with BASDAI, ASDAS, BASFI, and ASQoL (p&lt;0.05).Conclusion. Enthesitis may lead to decreased functional capacity and loss of quality of life in ax-SpA patients. Subclinical enthesitis in the feet of patients with SpA is not rare and may be detected by USG.

Musculoskeletal Ultrasound Assessment of Enthesopathy in Fibromyalgia Patients

Background: Fibromyalgia (FM) is a syndrome of persistent widespread pain, stiffness, fatigue, disrupted and unrefreshing sleep, and cognitive difficulties, often accompanied by multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of activities of daily living Objectives: To assess the frequency and pattern of enthesopathy in primary FM using musculoskeletal ultrasound with Glasgow Ultrasound Enthesitis Scoring System (GUESS) and Correlate these findings with clinical and laboratory parameters of FM. Patients and Methods: A cross-sectional study includes 100 persons divided into two groups as follows: Group (1): 50 patients with primary fibromyalgia syndrome (FM) were diagnosed. Group (2): 50 apparently healthy controls with comparable age and sex. Patients were selected from those attending the outpatient clinic of the Rheumatology & Rehabilitation Department of Al-Azhar University Hospital, Assiut. Results: There is no statistically significant difference between cases and control groups regarding age, gender, and BMI (P>0.05 for each), there were no statistically significant correlations between the GUESS scores and any of the clinical characteristics of FM patients. Although non-significant, these correlations were negative between the GUESS score and the tender point number, the Widespread Pain Index as well as the Fibromyalgia Impact Questionnaire. The total GUESS score of the FM group ranged between 0-12 with a mean ±SD of 5.3 ± 2.8. The total GUESS score of control group ranged between 0-6 with a mean ±SD of 0.97± 1.58, with a significant difference between the two groups (P<0.05) Conclusion: There were significant enthesopathic changes detected among FM patients especially affecting the Achilles, quadriceps, and proximal patellar tendons.

Musculoskeletal Ultrasound Assessment of Enthesopathy in Fibromyalgia Patients

Background: Fibromyalgia (FM) is a syndrome of persistent widespread pain, stiffness, fatigue, disrupted and unrefreshing sleep, and cognitive difficulties, often accompanied by multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of activities of daily living Objectives: To assess the frequency and pattern of enthesopathy in primary FM using musculoskeletal ultrasound with Glasgow Ultrasound Enthesitis Scoring System (GUESS) and Correlate these findings with clinical and laboratory parameters of FM. Patients and Methods: A cross-sectional study includes 100 persons divided into two groups as follows: Group (1): 50 patients with primary fibromyalgia syndrome (FM) were diagnosed. Group (2): 50 apparently healthy controls with comparable age and sex. Patients were selected from those attending the outpatient clinic of the Rheumatology & Rehabilitation Department of Al-Azhar University Hospital, Assiut. Results: There is no statistically significant difference between cases and control groups regarding age, gender, and BMI (P>0.05 for each), there were no statistically significant correlations between the GUESS scores and any of the clinical characteristics of FM patients. Although non-significant, these correlations were negative between the GUESS score and the tender point number, the Widespread Pain Index as well as the Fibromyalgia Impact Questionnaire. The total GUESS score of the FM group ranged between 0-12 with a mean ±SD of 5.3 ± 2.8. The total GUESS score of control group ranged between 0-6 with a mean ±SD of 0.97± 1.58, with a significant difference between the two groups (P<0.05) Conclusion: There were significant enthesopathic changes detected among FM patients especially affecting the Achilles, quadriceps, and proximal patellar tendons.

Enthesopathy in rheumatoid arthritis and spondyloarthritis: An ultrasound study

ObjectiveWe aimed to compare the prevalence of enthesopathy seen on ultrasonography (US) in spondyloarthritis (SpA) and rheumatoid arthritis (RA) and compared it to healthy controls. MethodsAll included patients with RA (2010 ACR/EULAR criteria) and SpA (ASAS criteria) and healthy controls underwent clinical and US evaluation of enthesis at seven sites (quadriceps, proximal and distal patellar, Achilles and triceps tendons, plantar aponeurosis and lateral epicondyle enthesis). The Glasgow Ultrasound Enthesitis Scoring System (GUESS) and the Madrid Sonographic Enthesitis Index (MASEI) scores were determined by two sonographers blinded to clinical data. ResultsWe included 30 patients with RA (mean age: 55.7±14.8 years, mean disease duration 10.5±7.9years); 41 with SpA (mean age: 45.3±15.4 years, mean disease duration 9.2±8.7years) and 26 healthy controls (HC) (mean age: 50.4±17.3years). Patients with SpA and RA had similar prevalence of painful enthesis of examined sites (17% vs. 14%, non-significant [ns]), but more than among in healthy controls (3%, P<0.05 for RA and SpA comparison). Comparison between SpA and RA patients revealed that at least one US enthesis abnormality was found with similar frequency (46% and 48% sites [ns]) but both rheumatic diseases had higher frequency of US enthesis abnormality than HC (31%, P<0.05 for RA and SpA comparison). The mean MASEI score was 8.5±7.3 for RA patients, 7.8±6.5 for SpA patients (ns) and 3.4±2.8 for healthy controls (P<0.05 for RA and SpA comparison). Overall, 6 RA (20%) and 4 SpA (10%) patients had a MASEI score≥18 (ns). None of the healthy controls had a MASEI score≥18 (P<0.05 for RA and SpA comparison). The mean GUESS score was 5.8±3.1 and 6.3±3.9 for RA and SpA patients (ns), and 4.0±3.1 for healthy controls (P<0.01 vs. SpA and <0.05 vs. RA). ConclusionsRA and SpA patients did not differ in entheseal abnormalities seen on US. Such US features may have low specificity in inflammatory conditions affecting joints and enthesis such as SpA and RA.

Musculoskeletal ultrasonographic evaluation of lower limb enthesopathy in ankylosing spondylitis and Behçet’s disease: Relation to clinical status and disease activity

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.

Musculoskeletal ultrasonographic evaluation of lower limb enthesopathy in ankylosing spondylitis and Behçet’s disease: Relation to clinical status and disease activity

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.

Ultrasonography of peripheral entheses in the diagnosis and understanding of diffuse idiopathic skeletal hyperostosis (DISH).

The aim of this study was to investigate musculoskeletal ultrasound (MSUS) as a diagnostic modality in DISH and to explore whether it might help in elucidating its pathogenesis and events that precede the calcification/ossification process. Fifty patients with DISH and 34 patients with osteoarthritis of the lower limbs without DISH were investigated. Data regarding demographics and traditional cardiovascular risk factors were collected from all patients. An ultrasonography was performed according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS) by observers who were blinded to the diagnosis or the clinical findings in the patients. The total mean GUESS score for patients with DISH was 14.12 ± 5.2 and for patients without DISH 5.32 ± 4.99 (P < 0.0001). Univariate logistic regression analysis found a strong association between the GUESS and the probability of having DISH (P < 0.0001). The area under the ROC curve (AUC) revealed that the GUESS accuracy in diagnosing DISH was 88.53% with sensitivity and specificity of 92 and 70.6%, respectively, at a cutoff value of 6.36. A stepwise logistic regression analysis of the statistically significant items in the GUESS isolated four items, and the presence of either all of them or the first three items yielded the likelihood of having DISH to be 98.8 and 90.6%, respectively. The GUESS and the stepwise logistic regression analysis of the GUESS items demonstrated a high likelihood of having DISH. MSUS might help to identify entheseal changes in DISH. Further studies are needed to confirm these results.

Patients with Inflammatory Bowel Disease have Higher Sonographic Enthesitis Scores than Normal Individuals: Pilot Study in Taiwan

Background If a patient has inflammatory bowel disease (IBD) and enthesitis, he/she can be classified as having peripheral spondyloarthritis according to criteria set by the Assessment of Spondyloarthritis International Society. In Taiwan, IBD patients visiting outpatient clinics can present without joint symptoms, so the prevalence of these musculoskeletal manifestations may be underestimated. We conducted this study to evaluate enthesitis by ultrasonography (US) in IBD patients, and compared these data with healthy controls (HCs). Materials and methods Fourteen IBD patients and 14 HCs underwent independent clinical and ultrasonographic examination of both legs at five entheseal sites. The Glasgow Ultrasound Enthesitis Scoring System (GUESS) was used to assess the degree of enthesitis in the two groups. The total score of enthesitis was calculated on the basis of US findings. All US examinations were undertaken by an experienced rheumatologist blinded to clinical and laboratory findings. Results Two hundred and eighty entheses in 14 patients and 14 HCs were examined by US, which revealed 42/140 (30%) and 21/140 (15%) abnormal entheseal sites in patients and controls, respectively. The GUESS score was significantly higher in IBD patients than in HCs ( p Conclusion These data suggest that US is more sensitive than radiography and clinical assessment for the detection of entheseal abnormalities.

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...

AB0923 Subclinical entheseal involvement in patients with psoriasis: A case-control ultrasound study

BackgroundUltrasonography (US) can demonstrate early abnormalities in entheses of asymptomatic patients. The existence of pre-clinical entheseal involvement in patients with psoriasis is debated.ObjectivesTo verify by US the presence of subclinical...

Enthesopathy in patients with familial Mediterranean fever: increased prevalence in M694 V variant

Enthesopathy is pathology of bony insertions of tendons, ligaments or joint capsules. It is a frequent finding in rheumatic diseases, like ankylosing spondylitis (AS) and Behçet's disease. Musculoskeletal complaints are common in patients with familial Mediterranean fever (FMF), and these could be a clinical manifestation of enthesopathy. Hence, we investigated the possible association between FMF and enthesopathy. Fifty-six patients with FMF and 11 patients with FMF-associated spondyloarthropathy (FMFS) were enrolled. Forty-seven healthy individuals and 36 patients with AS formed the healthy and diseased control groups. Musculoskeletal complaints were meticulously questioned, and all patients underwent a detailed physical and ultrasonographic (US) examination of the lower limbs. US scorings of enthesopathy was performed according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Demographic data, disease characteristics, MEFV genotypes and HLA B27 results were retrieved from the medical records. Patient-reported pain and physical examination findings consistent with enthesopathy were frequent in all groups with the highest prevalence in the FMFS group. Heel was the most common region affected in all patient groups. FMF patients harboring M694 V variant had higher GUESS scores compared to patients with other variants (2.78 ± 2.43 vs. 1.37 ± 1.67, p = 0.026). There was no statistically significant difference in the mean ± SD GUESS scores between healthy subjects and those FMF patients with genetic variants other than M694 V (1.38 ± 1.42 vs. 1.37 ± 1.67, p > 0.05). Enthesopathy may not be a feature of general FMF population; rather, it might be specifically associated with the presence of M694 V variant. Our results further support the previous evidence regarding M694 V mutation and spondyloarthropathy association.

Ultrasonographic evaluation of lower limb enthesis in patients with early spondyloarthropathies

IntroductionThe enthesopathy of seronegative spondyloarthropathies (SpA) is the hallmark of these diseases, the ultrasound examination of these entheses confirms the frequency of their involvement. Aim of the workTo detect entheseal abnormalities with ultrasound (US) in the lower limb of patients with early spondyloarthropathy (SpA) and to evaluate US as a valuable tool in detecting early enthesis. Patients and methodsA total of 45 patients with early disease duration of 11.7±8.5months, including 10 patients with psoriatic arthritis (PsA), 10 patients with ankylosing spondylitis (AS), 10 patients with reactive arthritis (ReA), eight patients with ulcerative colitis (UC) and seven patients with Crohn’s disease and 20 healthy controls of matched age and sex underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). ResultsOn US examination a total of 290/450 (64.4%) of the entheseal sites were abnormal. Mean GUESS score was significantly higher in patients with SpA as compared with controls (p<0.001), with a higher mean value in patients with PsA, ReA and AS. The mean thickness of all tendons examined was significantly higher in SpA patients than in controls (p<0.0001) as well as the mean number of enthesophytes and bursitis in all sites examined (p=0.002, p=0.003), with a higher prevalence amongst patients with PsA and ReA. The GUESS score was correlated to duration of the disease and the anti-tumour necrosis factor alpha medications. ConclusionEnthesis involvement occurs early in spondyloarthritis, the enthesis US score appears to be reliable and useful for improving the diagnostic accuracy of early SpA, further studies are needed as US is an evolving technique.

Sonographic subclinical entheseal involvement in dialysis patients

Long-term dialysis treatment can be associated with several musculoskeletal complications. Entheseal involvement in dialysis patients remains rarely studied as its prevalence is underestimated due to its often asymptomatic presentation. The aims of the study were to determine the prevalence of subclinical enthesopathy in haemodialysis and peritoneal dialysis patients at the lower limb level, to investigate the inter-observer reliability of ultrasound assessment and to analyse the influence of biometric and biochemical parameters. Ultrasound examination was conducted at the entheses of the lower limbs level in 33 asymptomatic dialysis patients and 33 healthy adopting the Glasgow Ultrasound Enthesitis Scoring System (GUESS). The inter-observer reliability was calculated in 15 dialysis patients. Ultrasound found at least one sign of enthesopathy in 165 out of 330 (50%) entheses of dialysis patients. In healthy subjects, signs of enthesopathy were present in 54 out of 330 (16.3%) entheses (p < 0.0001). No power Doppler signal was detected in healthy controls, in contrast to four of 330 entheses of dialysis patients. No US signs of soft tissue amyloid deposits were found. The GUESS score was significantly higher in dialysis patients than in controls (p < 0.0001). There was no difference in terms of enthesopathy between haemodialysis and peritoneal dialysis. Dialysis duration resulted to be the most important predictor for enthesopathy (p = 0.0004), followed by patient age (p = 0.02) and body mass index (p = 0.035). Parathormone, calcium, phosphorus, C-reactive protein, cholesterol and triglycerides apparently did not play a relevant role in favour of enthesopathy. The inter-observer reliability showed an excellent agreement between sonographers with different degree of experience. Our results demonstrated a higher prevalence of subclinical enthesopathy in both haemodialysis and peritoneal dialysis patients than in healthy subjects. Follow-up will provide further information with respect to the predictive value of US findings for the development of symptomatic dialysis-related arthropathy.

Subclinical Entheseal Involvement in Patients with Psoriasis: An Ultrasound Study

The main aim of the present study was to determine the prevalence of subclinical entheseal involvement at lower limbs by ultrasound (US) in patients with psoriasis. The secondary aim was to determine the interobserver reliability of the Glasgow Ultrasound Enthesitis Scoring System (GUESS) and power Doppler (PD) technique in the assessment of enthesopathy. The study was conducted on 45 patients with psoriasis and 45 healthy sex- and age-matched controls. All patients with no clinical evidence of arthritis or enthesitis underwent an US examination. All US findings were identified according to GUESS. The interobserver reliability was calculated in 15 patients with psoriasis. A total of 450 entheses in 45 patients with psoriasis were evaluated by US. In 148 of 450 (32.9%) entheses, grayscale US found signs indicative of enthesopathy. In 4/450 (0.9%) entheses PD signal was detected. In the healthy population, US found signs of enthesopathy in 38 of 450 (8.4%) entheses and no PD signal was detected. The GUESS score was significantly higher in patients with psoriasis than in healthy controls (P < 0.0001). Both concordance correlation coefficient and unweighted κ values for US findings showed an excellent agreement (0.906 and 0.890, respectively). Our results indicate that both grayscale US and PD findings indicative of enthesopathy were more frequent in patients with psoriasis. The US ability to detect signs of subclinical enthesopathy should be the object of longitudinal investigations to define its value in predicting the clinical onset of psoriatic arthritis.

Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study

Background: Psoriasis is associated with a form of spondyloarthropathy in 10–30% of cases. A major feature of psoriatic arthritis is enthesitis. In some patients with psoriasis the presence of enthesitis...

Sonographic evaluation of entheseal sites of the lower extremity in patients undergoing hemodialysis

To evaluate the entheseal sites of the lower extremities in patients on hemodialysis using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) and to correlate the findings with the duration of hemodialysis and patient scores. Forty-nine patients who were on hemodialysis for at least 2 years were grouped according to duration of hemodialysis. Total GUESS scores; total enthesophyte, erosion, and bursitis scores; and tendon thicknesses were calculated, compared between groups, and correlated with duration of dialysis. There was a statistically significant correlation between duration of hemodialysis and total GUESS score (p < 0.001, r = 0.81) and also between the total enthesophyte and erosion scores (p < 0.001). If severe enthesitis was defined as a total GUESS score of more than 18, receiver operating characteristic (ROC) curve analysis revealed that a cutoff point of 10 years for the duration of hemodialysis would predict severe enthesal damage with 83% sensitivity and 93% specificity (area under the ROC curve, 0.92; 95% confidence interval, 0.83-1.00). Hemodialysis results in entheseal site changes that worsen with extended duration of hemodialysis, especially after 10 years.