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Belgrade Ultrasound Enthesitis Score may be useful to help identify patients with SpA
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The Belgrade Ultrasound Enthesitis Score appeared to be a reliable and valid method for distinguishing patients with spondyloarthritis from patients with enthesitis without spondyloarthritis, according to recently published research.
Researchers recruited 76 patients with spondyloarthritis (SpA) who met European
Spondyloarthritis Study Group (ESSG) criteria, 26 patients with rheumatoid arthritis (RA) who met American College of Rheumatology (ACR) 1988 criteria or the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria and 25 patients with mechanically associated enthesitis. Of patients with SpA, 39 had ankylosing spondylitis (AS) by modified New York criteria, 27 had psoriatic arthritis (PsA) as defined by Classification Criteria for Psoriatic Arthritis (CASPAR), six patients had reactive arthritis according to Wilkens, et al criteria and four patients had undifferentiated SpA.
Two ultrasound operators blinded to patient data performed consecutive ultrasound examinations with a Logiq9 (GE Medical Systems) with a M12L Matrix Array 5 to 13 MHz linear probe. Low flow Doppler settings were selected with a low wall filter, and selected pulse frequency repetition (PRF) was between 500 and 750 after adjustment to the highest level of sensitivity at the lowest possible value for each site.
Bilateral exploration of the plantar fascia, Achilles tendon, patellar tendon distal and patellar tendon proximal insertion, quadriceps tendon and common extensor tendon on the lateral epicondyle were performed along longitudinal and transverse planes.
Tendon thickness, hypoechogenicity, enthesophytes, Doppler signal at the entheses and erosions were measured and scored from 0 to 4. The Belgrade Ultrasound Enthesitis Score (BUSES) was the total cumulative score. The examinations lasted for approximately 15 minutes.
Mean BUSES were significantly different between patients with SpA, patients without SpA and patients with AS. The total BUSES was 9.9 in patients with SpA, 11.8 in patients with AS and 3.1 in patients RA or mechanical enthesitis without SpA. Operator agreement was high, according to the researchers.
“Because of the high specificity, BUSES could be used to reduce the time between the onset of SpA and its diagnosis,” the researchers wrote. “Reliability of BUSES was confirmed by the excellence of interobserver agreement which was close to 1. BUSES has good feasibility as well.” – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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