12/16/2025
According to a recent study published in RMD Open, ultrasounds of enthesitis sites can serve as a useful tool in distinguishing patients with spondyloarthritis (SpA) from those without it. The study also suggests that certain entheses are most indicative of spondyloarthritis. These include:
Inflammatory changes such as thickening and darker-than-normal tissue seen on grayscale ultrasound at these sites were identified as the strongest markers of SpA. The presence of bone erosions also helped with diagnosing SpA.
The study included 121 participants from six Swiss hospital outpatient clinics. Forty-one participants had psoriatic arthritis (PsA), 39 had axial spondyloarthritis (axSpA), and 41 did not have SpA. They underwent clinical examinations of joints and entheses, completed questionnaires on physical activity and quality of life, and received musculoskeletal ultrasounds of nine entheseal sites on both sides of the body. The researchers scored ultrasound lesions according to standardized criteria and used statistical analysis to determine which lesions and sites best distinguished SpA patients from healthy individuals.
In addition to the above findings about which entheses indicate SpA, there were other key findings. Structural lesions such as enthesophytes (bony growths) and calcifications (deposits of calcium in soft tissues) were common even in individuals without SpA, suggesting that structural lesions aren’t the most useful in diagnosing SpA. Patients with axSpA tended to have more erosions than those with PsA. Bursitis was slightly more common in PsA at some sites.
The study has several limitations. The sample size was relatively small and limited to Swiss hospital outpatient clinics; the results may not necessarily apply to other populations. Ultrasound assessments were performed by highly experienced clinicians, so results might differ in settings without such technicians. Additionally, the study focused on a limited number of entheseal sites, meaning other relevant locations could have been missed.
According to the researchers, the study is valuable because focusing on the most indicative entheses allows for earlier and more accurate diagnosis. Targeted ultrasounds could also mean fewer unnecessary tests and less stressful appointments. Finally, understanding which lesions reflect SpA could help patients better understand their condition and actively participate in treatment decisions, improving overall disease management.
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