Ultrasound vs Clinical Assessment of Peripheral Enthesitis in PsA and Fibromyalgia

Ultrasound Examination In Doctors Office. Female doctor sitting and working
Researchers evaluated the prevalence of clinical and ultrasonographic entheseal involvement in patients with psoriatic arthritis, psoriasis, and fibromyalgia.

Enthesitis was a common feature in patients with psoriatic arthritis (PsA) and psoriasis, although ultrasonographic findings among those with psoriasis were less pronounced than in those with PsA, according to the results of the cross-sectional, multicenter ULISSE study published in The Journal of Rheumatology. Moreover, enthesitis defined by tenderness on pressure was quite common among patients with fibromyalgia syndrome (FMS), which was a clear indication of the poor specificity of this definition of enthesitis.

The investigators sought to evaluate the prevalence of clinical and ultrasonographic entheseal involvement in patients with PsA, psoriasis, and FMS. All patients with PsA and psoriasis (not receiving systemic therapy) and FMS underwent a clinical evaluation of the entheses, along with

B-mode and power Doppler examination of 6 pairs of entheses.

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A total of 140 patients with PsA, 51 with psoriasis, and 51 with FMS were enrolled in the study. Clinical and ultrasonographic examinations were conducted in 1960 and 1680 entheses in the PsA group, along with 714 and 612 entheses in both the psoriasis and the FMS groups. In both per patient and per enthesis assessment, the frequency of entheseal tenderness was higher among patients with FMS (92% of the patients and 46% of the entheses) compared with patients with PsA (66% of patients and 23% of entheses) and patients with psoriasis (59% of patients and 18% of entheses).

On ultrasound examination, signs of entheseal involvement were more common in both the per patient and per entheses assessments in PsA and psoriasis. Approximately 90% of patients in both the PsA and psoriasis groups, as well as 75% of participants in the FMS group, had ≥1 site affected, and 54%, 41%, and 27% of the pairs of entheses in patients with PsA, psoriasis, and FMS, respectively, demonstrated involvement of ≥1 enthesis.

The investigators concluded that according to the results from the ULISSE study, enthesitis is a frequent feature in patients with PsA, psoriasis, and FMS if only clinical examination is used. Ultrasonographic entheseal evaluation demonstrated findings more consistent with the 3 conditions. A combination of clinical and ultrasound findings might prove to be the best approach for generating a more reliable definition of enthesitis.


Macchioni P, Salvarani C, Possemato N, et al. Ultrasonographic and clinical assessment of peripheral enthesitis in patients with psoriatic arthritis, psoriasis, and fibromyalgia syndrome: the ULISSE study [published online March 15, 2019]. J Rheumatol. doi: 10.3899/jrheum.171411