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Enthesis erosion in spondyloarthritis is not a persistent structural lesion
  1. Eugenio de Miguel1,
  2. Sandra Falcao2,
  3. Concepción Castillo1,
  4. Chamaida Plasencia1,
  5. Miriam García1,
  6. Jaime C Branco2,
  7. Emilio Martín-Mola1
  1. 1Rheumatology, La Paz University Hospital, Madrid, Spain
  2. 2Rheumatology, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal
  1. Correspondence to Dr Eugenio de Miguel, Rheumatology Unit, La Paz University Hospital, Pª de la Castellana 261, 28046 Madrid, Spain; eugenio.demiguel{at}


Objective To evaluate the ability of ultrasound (US) to detect the presence and change of Achilles erosions in spondyloarthritis (SpA).

Methods A blind prospective two-dimensional (2D) and three-dimensional (3D) US study of Achilles enthesis erosions in early SpA was undertaken. US examinations were performed at baseline and at 6 and 12 months of follow-up. Clinical outcomes measures were collected.

Results Bilateral Achilles entheses of 68 patients (35 women) were investigated. The mean Bath Ankylosing Spondylitis Disease Activity Index and C reactive protein (CRP) levels were 4.58±2.05 and 5.97±9.91 mg/l, respectively. The κ values for intrareader agreement for 2D and 3D images were 0.84 and 0.85 for two readers. 2D US visualised 10 erosions (7.4%) and 3D US visualised 13 erosions (9.6%) in 10 patients (14.7%). At 6 and 12 months of follow-up, 25% and 50% of basal erosions had disappeared, respectively and, of the new erosions that appeared at 6 months, 40% had disappeared 6 months later. A statistically significant association between erosion and CRP levels, entheseal Doppler signals and the number of tender and swollen joints was found.

Conclusions US examination of Achilles erosions is reliable and sensitive to change. An association was found between Achilles erosions and objective activity-based measurements of SpA outcomes.

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  • Funding This study was supported by an unrestricted grant from the Spanish Rheumatology Foundation and Pfizer (ESPERANZA programme).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted according to local regulations and the Declaration of Helsinki, and local approval was obtained from the ethical committee and institutional review board of the Hospital Universitario La Paz, Madrid, Spain.

  • Provenance and peer review Not commissioned; externally peer reviewed.