Diagnostic values of history and clinical examination to predict ultrasound signs of chronic and acute enthesitis.
OBJECTIVE
To examine the diagnostic values of history of chronic enthesitic pain and clinical signs of acutely inflamed entheses to predict ultrasound (US) signs of enthesitis.


METHODS
Cohort study of 21 consecutive rheumatic out-patients (female/male 18/3) with suspected multiple enthesitis and 12 controls (female/male 10/2). 429 enthesal sites according to the Maastricht Ankylosing Spondylitis Entheses Score (MASES) were evaluated by history, clinical examination, B-mode and power Doppler US. Sensitivity and specificity of history suggesting chronic enthesitic pain and clinical examination suggesting acute enthesitis were calculated using corresponding US findings as reference standard.


RESULTS
Diagnostic accuracy widely varied between different MASES sites. Sensitivity and specificity of selected MASES points were 66.7 - 86.4% and 85.0 - 91.7% for history and 71.4 - 87.0% and 47.4 - 75.0% for clinical examination, respectively (p<0.05 for each).


CONCLUSIONS
At specific enthesal sites, history of chronic enthesitic pain and clinical signs of acute inflammation are sensitive and specific for the diagnosis of chronic and/or acute inflammation.
Klauser
A S
AS
Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria.
Wipfler
E
E
Dejaco
C
C
Moriggl
B
B
Duftner
C
C
Schirmer
M
M
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D052256:Tendinopathy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014463:Ultrasonography