Rheumatology International

, Volume 38, Issue 11, pp 2053–2061 | Cite as

Is ultrasonographic enthesitis evaluation helpful for diagnosis of non-radiographic axial spondyloarthritis?

  • Tugba Ozsoy-Unubol
  • Ilker YagciEmail author


The aim of this study is to evaluate the diagnostic utility of ultrasonographic enthesitis assessment in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and to compare different sonographic scoring methods. Patients with nr-axSpA (n = 30) and mechanical back pain (MBP) (n = 30) were enrolled in the study with standardized clinical criteria. For both of the groups, a total of 18 entheses were evaluated in each patient with B mode ultrasound and power Doppler by a sonographer who is blinded to initial clinical and radiological assessments. Glasgow Ultrasound Enthesitis Scoring System (GUESS), Madrid Sonographic Enthesitis Index (MASEI) and D’Agostino grading system were performed. Intra-rater and inter-rater reliability analyses were evaluated with the intraclass correlation coefficient (ICC). There was at least one enthesitis in 96.7% of patients with nr-axSpA. Median values of the number of enthesitis were 5 in nr-axSpA and 0 in MBP. Mean GUESS total scores were 0.9 in MBP and 4.5 in nr-axSpA. Mean MASEI total scores were 2.3 and 10.5, respectively. The sensitivities were 96.7% and 93.3% for GUESS and MASEI while the detected specificities were 80% for both methods. For Intra-rater reliability analysis, ICC was calculated as 0.981 for GUESS and 0.975 for MASEI, while it was calculated as 0.964 and 0.962 for inter-rater reliability analysis. Thus, evaluation of enthesitis with ultrasound is a reliable, helpful tool for the distinction of patients with nr-axSpA from patients with MBP. We favored the use of MASEI because of assessing upper extremity, using power Doppler and having a correlation with disease activity.


Enthesitis GUESS MASEI Non-radiographic axial spondyloarthritis Ultrasonography 



There is no support from any external editing agency.

Author contributions

TOU and IY: conception, design, analysis and interpretation of the data, statistical analysis, manuscript preparation, revision and final approval of the version to be published.


There has been no significant financial support for this work that could have influenced its outcome.

Compliance with ethical standards

Conflict of interest

All the authors have no conflict of interest to declare.

Ethical standards

All procedures performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by local ethic committee of Marmara University School of Medicine [approval number: (09.2015.125/70737436-050.06.04-)]. The manuscript has two authors and each author is responsible for the content and writing of the paper.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Physical Medicine and RehabilitationSultan Abdülhamid Han Training and Research HospitalIstanbulTurkey
  2. 2.Physical Medicine and RehabilitationMarmara University School of MedicineIstanbulTurkey

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