Enthesitis in psoriatic arthritis: Clinical assessment and association with disease characteristics

Background. Despite the integration of imaging methods such as ultrasound and magnetic resonance imaging for the detection of enthesitis, clinical assessment remains the foundation of diagnosis in both everyday practice and clinical studies. However, the frequency of detecting enthesitis in patients with psoriatic arthritis (PsA) varies considerably, which may be primarily due to differences in assessment methods.

The aim – to evaluate the frequency of enthesitis in patients with psoriatic arthritis using modern assessment scales and to investigate the association between enthesitis measures and disease characteristics.

Materials and methods. This cross-sectional study included 116 patients with PsA diagnosed according to the CASPAR (ClASsification for Psoriatic ARthritis) criteria. Enthesitis was assessed using the Leeds Enthesitis Index (LEI), the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), the Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC), and a combination of these indices.

Results. A total of 96 (82.8%) patients had at least one tender enthesis. Among these, 47 (49%) patients had tenderness at 1–3 entheses (1 enthesis – 19.8%; 2 entheses – 18.8%; 3 entheses – 10.4%), while the remaining patients had tenderness at 4 or more entheses. The median values of the indices were as follows: LEI – 1.0 [0.0; 2.25], SPARCC – 3.0 [1.0; 5.25], MASES – 1.0 [0.0; 2.0]. The frequency of enthesitis (at least one tender enthesis) according to each index was: LEI – 60 (62.5%) patients, MASES – 61 (63.5%) patients, SPARCC – 84 (87.5%) patients. In 9 (9.4%) patients, MASES identified one or more enthesitis sites, whereas no tender entheses were detected by SPARCC or LEI. A moderate positive correlation was found between body mass index (BMI) and the SPARCC index (ρ=0.32; p=0.001). Patients with normal BMI had lower values for the number of tender entheses (3 [1; 5] vs. 4 [2; 10]; p=0.043), the SPARCC index (2 [1; 3] vs. 3 [1; 6]; p=0.025), and the combined SPARCC + MASES index (4 [1; 11] vs. 6.5 [5; 11]; p=0.034).

Conclusion. Enthesitis is present in a significant proportion of patients with PsA (82.1%). To improve the detection rate of enthesitis in patients with PsA, the combined use of the SPARCC and MASES indices is preferable.

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