title: Assessment of enthesitis in patients with psoriatic arthritis using clinical examination and ultrasound.
abstract: BACKGROUND
  Enthesitis is a major feature of psoriatic arthritis. However, clinical assessment of enthesitis is known to lack accuracy and have poor interobserver reliability.
  
  
  OBJECTIVE
  To determine effect of training on clinical assessment of enthesitis and to compare ultrasonography with clinical examination for the detection of entheseal abnormalities.
  
  
  METHODS
  20 rheumatologists performed repeated assessment of enthesitis in patients with established psoriatic arthritis before and after a 2-hour training session in standardised enthesitis count according to Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC). Moreover, 20 patients underwent clinical and ultrasonographic examination of entheses to evaluate consensus-based elementary lesions of enthesitis.
  
  
  RESULTS
  Training significantly increased Intra-class Correlation Coefficient for LEI from 0.18 to 0.82 and for SPARCC from 0.38 to 0.67. Ultrasound examination showed high associations between hypoechogenicity and increased thickness of the entheses and clinical examination. There was no correlation between erosions and enthesophytes found by ultrasound and clinical assessments.
  
  
  CONCLUSIONS
  Training in standardised enthesitis scoring systems significantly improved clinical assessments of enthesitis and should be performed before use in daily clinical practice. Ultrasound revealed more advanced stages of enthesitis, such as enthesophytes and erosions, which were not detected with clinical examination.
authors.affiliation: Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Salome
authors.initials: S
authors.lastname: Kristensen
authors.affiliation: Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jeppe Hagstrup
authors.initials: JH
authors.lastname: Christensen
authors.affiliation: Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Erik Berg
authors.initials: EB
authors.lastname: Schmidt
authors.affiliation: Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Jens Lykkegaard
authors.initials: JL
authors.lastname: Olesen
authors.affiliation: Department of Cardiology and Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Martin Berg
authors.initials: MB
authors.lastname: Johansen
authors.affiliation: Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kristian Bakke
authors.initials: KB
authors.lastname: Arvesen
authors.affiliation: Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Schlemmer
keywords: SPARCC; enthesitis; leeds enthesitis index; psoriatic arthritis; ultrasound