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Value of musculoskeletal ultrasonography in the diagnosis of peripheral enthesopathy in early spondyloarthropathy



The aim of the study was to evaluate peripheral enthesopathy ultrasonography in early spondyloarthritis.

Patients and methods

A total of 50 patients were divided into two groups: group I included 30 patients who were diagnosed as spondyloarthropathy (SpA) and were divided into two subgroups – axial subgroup (19 patients) and peripheral subgroup (11 patients) – and group II included 20 patients diagnosed as rheumatoid arthritis. All patients were subjected to history taking, clinical examination and laboratory and radiological investigations: plain radiography and musculoskeletal ultrasonography.


A significant difference was found between subgroups regarding clinical examination of plantar fascia, distal patellar ligament and proximal patellar ligament. We found a high significant difference between mean of Bath Ankylosing Spondylitis Metrology Index (BASMI) in axial (0.8 ± 0.6) and peripheral (0.09 ± 0.3) patients. A high significant difference was found between group I and group II regarding Madrid Sonographic Enthesitis Index (MASEI). In addition, a significant difference was found regarding the number of abnormal enthesis examined by ultrasonography. We found a highly significant difference between groups regarding structure, bursa, erosion, calcification and power Doppler scores (higher in group I); a significant difference was found between groups regarding distal patellar ligament thickness, calcification and power Doppler signal; proximal patellar ligament thickness, calcification and power Doppler and quadriceps tendon structure, thickness and power Doppler. We found significant difference between subgroups regarding structure score.


Enthesis are affected early in spondyloarthritis. MASEI score is a valuable tool for early diagnosis of SpA and can improve diagnostic accuracy of early SpA patients.


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Correspondence to Mohamed A. Ibrahim MD.

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Hassan, A.A., Darwish, A.F., Mohamed, F.A. et al. Value of musculoskeletal ultrasonography in the diagnosis of peripheral enthesopathy in early spondyloarthropathy. Egypt Rheumatol Rehabil 41, 51–57 (2014).

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