title: Clinical and ultrasonography assessment of peripheral enthesitis in ankylosing spondylitis.
abstract: OBJECTIVE
  The aim of this study was to compare clinical examination with power Doppler US (PDUS) in the detection of entheseal abnormalities in patients with AS.
  
  
  METHODS
  Thirty-six AS patients underwent clinical and PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; gluteus tendons at their insertion at the greater trochanter; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its proximal insertion at the inferior pole of the patella; patellar tendon at its distal insertion at the tibial tuberosity; Achilles tendon at its insertion at the calcaneus; and plantar aponeuroses at its insertion at the calcaneus.
  
  
  RESULTS
  Clinical and PDUS examination revealed at least one abnormal enthesis in 23 (63.9%) and 35 (97.2%) AS patients, respectively. Furthermore, of 432 entheses examined in our 36 AS patients, 64 (14.8%) were considered abnormal by clinical examination and 192 (44.4%) by PDUS. US abnormalities most commonly found were enthesophytes (31.7%), calcifications (33.7%), thickening (29.8%) and hypoechogenicity (26.6%). We found erosions and PD signals in 9.7 and 6% of examined entheseal sites, respectively. The evidence of entheseal abnormalities by clinical examination has a poor likelihood ratio (LR) for the presence of US abnormalities with vascularization (LR = 1.61), without vascularization (LR = 1.24) or erosions (LR = 1.51) at all sites.
  
  
  CONCLUSIONS
  PDUS permits detection of structural and inflammatory abnormalities of the enthesis in AS and may complement the physical examination in order to better evaluate enthesitis.
authors.affiliation: Dipartimento di Medicina Interna e Specialità Mediche, UOC di Reumatologia, Sapienza, Università di Roma, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy. a.spadaro.reuma@virgilio.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadaro
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Perrotta
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Modesti
authors.forename: Antongiulio
authors.initials: A
authors.lastname: Scarno
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology; D012216:Rheumatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D052256:Tendinopathy / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler / Q000379:methods*; D055815:Young Adult