Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital

Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Imaging of Common Rheumatic Joint Diseases Affecting the Upper Limbs

    Research output: Contribution to journalReviewResearchpeer-review

  2. Dose tapering and discontinuation of biological therapy in rheumatoid arthritis patients in routine care - 2-year outcomes and predictors

    Research output: Contribution to journalConference abstract in journalResearchpeer-review

  3. Imaging in peripheral and axial psoriatic arthritis: contributions to diagnosis, follow-up, prognosis and knowledge of pathogenesis

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Ultrasonography in gout: utility in diagnosis and monitoring

    Research output: Contribution to journalJournal articleResearchpeer-review

  • OMERACT Ultrasound Task Force members
View graph of relations

OBJECTIVES: To evaluate the reliability of consensus-based ultrasound (US) definitions of elementary components of enthesitis in spondyloarthritis (SpA) and psoriatic arthritis (PsA) and to evaluate which of them had the highest contribution to defining and scoring enthesitis.

METHODS: Eleven sonographers evaluated 40 entheses from five patients with SpA/PsA at four bilateral sites. Nine US elementary lesions were binary-scored: hypoechogenicity, thickened insertion, enthesophytes, calcifications, erosions, bone irregularities, bursitis and Doppler signal inside and around enthesis. Kappa statistics were used to evaluate reliability. Sonographers were also asked to state which lesions can be considered as inflammatory or structural and should be included in the final definition of enthesitis. Only the lesions, scored as present in at least 75% of the entheses considered as having an enthesitis, were included in the final definition.

RESULTS: The prevalence of detected lesions was quite low except for enthesophytes (55%) and bone irregularities (54%). Reliability ranged from poor to good (the lowest for thickened enthesis (kappa 0.1 (95% CI 0 to 0.7)) and the highest for enthesophytes (kappa 0.6 (95% CI 0.5 to 0.7)). When adjusted for low prevalence, kappa values increased for all lesions, with the best result observed for detecting Doppler signal at insertion (0.9) and for bursitis (0.8). The US components included in the final definition were hypoechogenicity, increased thickness at enthesis, erosions and calcifications/enthesophytes and Doppler signal at insertion.

CONCLUSION: By using a consensus-based stepwise approach, a final reliable US score and definition of enthesitis in SpA/PsA were produced. Further studies are sought for implementing this score in clinical trials and practice.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Issue number12
Pages (from-to)1730-1735
Number of pages6
Publication statusPublished - Dec 2018

Bibliographical note


ID: 56071329