Topography of entheseal lesions on ultrasound : a comparative study between axial spondyloarthritis, psoriatic arthritis and healthy controls

Article Article scientifique Article Topography of entheseal lesions on ultrasound : a comparative study between axial spondyloarthritis, psoriatic arthritis and healthy controls eng 2025-10-15 2025-10 author Elsehrawy Gehad Gamal Eid Abdou 0000-0002-1447-0543 Rheumatology, Geneva University Hospital, University of Geneva, Geneva, Switzerland 429398 author Courvoisier Delphine 0000-0002-1956-2607 Rheumatology, Geneva University Hospital, University of Geneva, Geneva, Switzerland 94475 Département de médecine (DEMED) author Deman Erik Rheumatology, University Hospital Basel, University of Basel, Basel, Switzerland author Dan Diana Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland author Micheroli Raphael 0000-0002-8918-7304 Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland author Zufferey Pascal Rheumatology, Fribourg Hospitals, Fribourg, Switzerland author Brulhart Laure Rhumatology, Neuchâtel Hospital, La Chaux-de-Fonds, Switzerland author Nissen Michael John 0000-0002-6326-1764 Rheumatology, Geneva University Hospital, University of Geneva, Geneva, Switzerland 708146 Département de médecine (DEMED) e006088 10.1136/rmdopen-2025-006088 41093632 2056-5933 PMC12530400 https://rmdopen.bmj.com/lookup/doi/10.1136/rmdopen-2025-006088 Objectives : To determine which anatomical sites and which ultrasonographic entheseal lesions are best able to discriminate between spondyloarthritis (SpA) patients and healthy controls (HC). Methods : We included patients with psoriatic arthritis (PsA) and axial SpA (axSpA), from six Swiss hospital outpatient clinics, as well as HC. Participants completed quality of life and physical activity questionnaires and underwent a clinical examination of both joints and entheses, followed by a detailed musculoskeletal ultrasound examination including nine entheseal sites bilaterally. Entheses were scored according to the Outcome Measures in Rheumatology criteria, with an additional evaluation of bursae and power Doppler (PD) in the 2–5 mm zone. Results : Overall, 121 participants were included, including 41 with PsA (mean age in years (SD), percentage male: 54.5±11.0, 63.4%), 39 with axSpA (45.1±10.0, 51.3%) and 41 HC (43.9±10.9, 56.1%), with a total of 2178 entheses evaluated. The PsA and axSpA groups showed no significant differences regarding inflammatory markers or disease activity scores. In the univariable analysis, all ultrasonographic lesions at the enthesis showed a significant association with SpA vs HC. Only B-mode inflammatory lesions (OR=1.38, p=0.034) and active enthesitis (OR=4.45, p=0.030) retained this association in multivariable analyses. While 4/9 entheses were associated with SpA in univariable analyses, only the distal patellar ligament insertion remained significantly associated with SpA (OR=1.74, p=0.039) in multivariable analyses. Conclusion : To distinguish SpA patients from controls, the sonographic scoring system used should account not only for the presence of specific entheseal lesions (structural and inflammatory) but also for the individual site affected. Arthritis, Psoriatic Autoimmune Diseases Axial Spondyloarthritis Spondylitis, Ankylosing Ultrasonography Dewey 616 56 Département de médecine 221 false 1291 Recherche clinique dans les rhumatismes inflammatoires 1010 875 Groupe Courvoisier RMD open 11 4 bfa18794-b8c3-454e-830c-b68c77107820 Article (Published version) Public Elsehrawy_SONAR_SpA_2025.pdf 1228872 application/pdf CC BY-NC-4.0 2309eab9444dec1d1fe7f81347b8fd24cc64d3ff01c43e9c5664cab7665e2c4d 9642da56-8671-4b0f-ad45-0a2d75e0da6d Supplemental data Public inline-supplementary-material-1.pdf 601328 application/pdf ce5abfd9186f0fdbfe36a310ca6b2c0523c199d1fe4210cda6f9fd56bfa4dc53 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Topography of entheseal lesions on ultrasound : a comparative study between axial spondyloarthritis, psoriatic arthritis and healthy controls	RMD open			2025	11	104

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Elsehrawy, Gehad Gamal Eid Abdou