الفهرس 
Anatomy of the EnthesisOnly 14 pages are availabe for public view
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Abstract
Abstract
Enthesitis is defined as inflammation of the tendon, ligament, or capsule insertion into the bone. It is considered an early and cardinal marker of spondyloarthropathy (SpA) diagnosis. There is a growing demand for more accurate methods to diagnose enthesitis as early as possible for a more efficient treatment delivery. Ultrasound (US) is considered a promising tool for the diagnosis of enthesitis. Our study aimed at assessing the correlation between US and disease activity as well as evaluating the ability of Glasgow Ultrasound Enthesitis Scoring Index (GUESS) and Sonographic Enthesitic Index (SEI) US scores to diagnose the condition. We designed a case-control-based study, in which 11 patients with spondyloarthropathy were included and 10 healthy subjects matched for age and sex were invited to participate. For each included subject, a thorough clinical and US assessment was performed on five different lower limb entheseal sites bilaterally. Results showed that among the 210 examined entheseal sites, 30 sites were for patients with active disease process; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4, whereas 80 sites were with inactive disease process. Hypo-echogenicity and Doppler signal at < 2 mm of bone surface were the only US findings with significant correlation to disease activity with p values≈0.006 and 0.03 respectively. 194 US abnormalities were detected among cases and only 68 abnormalities were found among controls [p value ≈ 0.024]. Most US abnormalities were reported among patients with PsA; 102/194 [52.58%] abnormalities. GUESS and SEI scores were significantly correlated with the underlying diagnosis of enthesitis, with a cut off value of about 0.986 for GUESS and 1 for SEI scores. In conclusion, Ultrasound proved to be a promising tool in assessing disease activity among patients with SpA yet should be combined with other clinical and laboratory data. Application of GUESS and SEI scores can assist in differentiating US findings caused by underlying SpA from those among normal healthy subjects.
Keywords: Ultrasound, Spondyloarthropathy, Enthesitis, Ankylosing spondylitis, Psoriatic Arthritis