Heel Enthesitis in axSpA Associated With Worse Scores on Outcome Measures

Heel enthesitis in axSpA was found to be associated with poorer scores on outcome measures after 2 years of follow-up.

In patients with radiographic axial spondyloarthritis (r-axSpA), the presence of heel enthesitis is associated with poorer scores on outcome measures, according to the results of a study presented at the American College of Rheumatology (ACR) Convergence 2022, held from November 10 to 14, in Philadelphia, Pennsylvania.

The researchers sought to evaluate the prevalence of heel enthesitis during physical exploration of patients with r-axSpA; to assess the association of heel enthesitis with higher patient-reported outcomes (PROs); and to examine the impact of heel enthesitis on outcome measures after 2 years of follow-up.

The study included patients with r-axSpA from the Spanish Rheumatology Spondyloarthritis Registry (REGISPONSER-AS) study. Participants were divided into 2 groups, according to the presence or absence of heel enthesitis on physical examination.

The PROs evaluated included global visual analog scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), and the mental and physical components from the 12-Item Short Form Survey (SF-12).

The achievement of a low disease activity is less likely in patients with this manifestation.

In addition to studying the effects of heel enthesitis on PROs over a period of 2 years, the researchers also evaluated the attainment of ASDAS Low Disease Activity (ASDAS-LDA) and ASDAS Inactive Disease (ASDAS-ID) between the 2 groups.

A total of 749 patients (mean age, 48.4 years; 75.3% men) were included in the study, 46 (6.1%) of whom had heel enthesitis at the study visit.

Results of the study showed that patients with vs without heel enthesitis had an increase in global VAS (β coefficient, 1.32; 95% CI, 0.52-2.12), BASDAI (β,1.49; 95% CI, 0.81-2.18), ASDAS (β, 0.45; 95% CI, 0.12-0.77), and BASFI (β, 9.54; 95% CI, 1.78-17.30), after adjustment for confounders.

After 2 years of follow-up, patients with heel enthesitis had higher scores in global VAS, BASDAI, ASDAS, and BASFI. Further, the percentage of participants who achieved ASDAS-LDA after the 2-year follow-up was significantly lower in those with heel enthesitis than in those without heel enthesitis (15.9% vs 31.5%, respectively;
P =.030). No differences in ASDAS-ID were reported between the 2 groups.

The researchers concluded that “The achievement of a low disease activity is less likely in patients with this manifestation [r-axSpA and heel enthesitis].”


Lopez-Medina C, Puche Larrubia MA, Ladehesa-Pineda I, Granados R, Font P,
Collantes E. The presence of heel enthesitis on physical exploration is associated with poorer outcomes after 2 years of follow-up in patients with radiographic axial spondyloarthritis. Presented at: ACR Convergence 2022; November 10-14; Philadelphia, PA. Abstract #0375.