Objectives To look for correlations between clinical, ultrasound (US) and disease activity scores of peripheral enthesitis in an SpA cohort.
Methods A prospective study of all SpAs meeting SpA ASAS criteria followed at EHS Ben Aknoun, over a period from January 2015 to April 2016. Seventeen entheseal sites were assessed bilaterally: insertions of supra-spinatus, infra-spinatus, sub-scapular, medial and lateral epicondylars, triceps brachialis, gluteus midius and minimus, quadricipital, proximal and distal insertion (patellar ligament, medial and lateral collateral ligament), Achilles tendon and plantar aponeurosis. Peripheral entheses was assessed by the following clinical scores: Enthesitis Peripheral Score (PES= Sum of symptomatic peripheral entheses sites on clinical examination), Visual Analog Scale of peripheral enthesitis (VAS), Spondyloarthritis Research Consortium of Canada score (SPARCC) as well as the following US enthesitis scores: Acute Enthesitis score (Sum of acute enthesitis US scores for each site), Chronic Enthesitis score (Sum of US chronic enthesitis scores for each site), Global Enthesitis score (Sum of the acute and chronic US scores of enthesitis), Doppler signal Enthesitis score (Sum of Doppler signal scores less than 2mm from cortical bone for each site), Madrid Sonography Enthesitis Index (MASEI), Simplified Echographic Score (SES) wich assesses only the Achilles tendon and the plantar aponeurosis. Correlations between clinical, activity and US scores were investigated by SPPSS software.
Results A total of 208 patients were included. At examination 88.9% had an active disease and 64.4% of SpA were taking NSAIDs. 6240 entheses were assessed clinically and with US. A positive correlation was found between activity scores and two clinical scores (Peripheral Enthesitis Score, SPARCC). A good correlation was found between Activity scores and all US scores on one hand and with SPARCC scores and PES scores on the other hand. For US and clinical correlations, only Doppler scores was positively correlated with 2 clinical scores (SPARCC and PES scores), Acute Enthesitis scores was correlated with the PES scores. No correlation was found between clinical scores and MASEI or SES scores. No correlation was found with the mean enthesitis VAS scores.
Conclusions All US enthesitis scores were correlated with disease activity scores but those correlated with the clinical symptoms and not with its intensity were: Acute Enthesitis Scores, Global Enthesitis Scores and especially Doppler signal Enthesitis Scores.
Disclosure of Interest None declared
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