Ultrasound detection of entheseal insertions in the foot of patients with spondyloarthropathy

The aim of the study was to evaluate entheseal involvement in the foot of patients with spondyloarthropathy (SpA) by ultrasonographic (US) examination and compare the results with clinical and radiological findings. Forty-four patients (27 men, 17 women) with a diagnosis of SpA were recruited. Patient evaluation included physical examination (swelling and pain), Bath Ankylosing Spondylitis Radiological Index, Bath Ankylosing Spondylitis Disease Activity, Bath Ankylosing Spondylitis Metrological Index, and laboratory parameters (erythrocyte sedimentation rate, C-reactive protein). Foot x-rays of the patients were assessed and scored according to SpA Tarsal Radiographic Index (SpA-TRI). A high-resolution US was used to examine the tendon and ligament insertion sites in the foot, and the findings were scored according to Glasgow Ultrasound Enthesitis Scoring System (GUESS). The mean age and disease duration of the patients were 39.9 +/- 12.5 and 9 +/- 8.2 years, respectively. US revealed pathological findings in 25 of 44 (56.8%) patients, most of whom exhibited no clinical signs of foot involvement. Pain and swelling at entheseal insertions were detected in only 16 (37%) patients. The mean GUESS score and SpA-TRI score were 2.2 +/- 2.5 and 3.3 +/- 3.7, respectively. There was a correlation between the scores of GUESS and SpA-TRI, particularly at the Achilles and plantar fascia insertion sites. The mean score of SpA-TRI was higher in patients with enthesopathy, detected by US, than in patients without enthesopathy (4.6 +/- 4.4 vs 1.8 +/- 2.1). There was no significant correlation between the mean GUESS score and clinical and laboratory variables. In conclusion, involvement of tendon and entheses is not rare, and US is a valuable diagnostic method in detecting subclinical enthesopathic changes. The GUESS and SpA-TRI are suggested in quantifying US and radiological changes in the foot of patients with SpA.