A clinical practice guideline for the screening and assessment of enthesitis in patients with spondyloarthritis

Abstract

ObjectiveThe aim of this review is to provide guidance on the selection of approaches to the screening and assessment of enthesitis in patients with spondyloarthritis (SpA).MethodsTwenty-four questions regarding the approaches to the screening and assessment of enthesitis and the implementation details were devised, followed by a systemic literature review. The Grading of Recommendations Assessment, Development, and Evaluation methodology was employed in the development of this guideline, with modifications to evaluate non-interventional approaches under comprehensive consideration of costs, accessibility, and evidence strength. A consensus from the voting panel was required for the inclusion of the final recommendations and the strength of each recommendation.ResultsSeventeen recommendations (including five strong recommendations) were included in this guideline. The voting panel expressed unequivocal support for the necessity of screening and assessment of enthesitis in patients with SpA. It was agreed unanimously that symptom evaluation and physical examination should serve as the initial steps to the recognition of enthesitis, whereas Maastricht Ankylosing Spondylitis Enthesitis Score is a reliable tool in both clinical trials and daily medical practice. Ultrasound examination is another reliable tool, with power Doppler ultrasound as an informative addition. Notwithstanding its high resolution, MRI is limited by the costs and relatively low accessibility, whereas radiographs had low sensitivity and therefore should be rendered obsolete in the assessment of enthesitis. PET/CT was strongly opposed in the detection of enthesitis.ConclusionThis guideline provides clinicians with information regarding the screening and assessment of enthesitis in patients with SpA. However, this guideline does not intend on dictating choices, and the ultimate decisions should be made in light of the actual circumstances of the facilities.

the serum ischemia modified albumin in patients with ankylosing spondylitis

“…Spinal Mobility was assessed by the several techniques [17]; as Schober test, assessment of the amount of chest expansion, range of Motion or the tragus to wall test is a test to measure cervical mobility. We used several techniques to assess the peripheral joints [18] and entheses [19] in patients with AS by examination of the large joints of the lower limbs for tenderness and/or swelling or examination for enthesitis at insertion sites around the pelvis (the ischial tuberosities, iliac crests, and greater trochanters) and enthesitis at the site of the insertion of the Achilles tendon and plantar fascia onto the calcaneus.The assessment of the disease activity and severity was done by using Bath Ankylosing Spondylitis Disease Activity Index; its score ranged from 0 (no disease activity) to 10 (very active disease) [20]. A cut-off of 4 was frequently used to define active disease [21], Ankylosing Spondylitis Disease Activity Score was a data-driven index that combined questions of patient reported outcomes (about back pain, peripheral pain/swelling, and duration of morning stiffness) as well as the patient global assessment of disease activity, with either the ESR or the CRP in a weighted manner [22], Bath Ankylosing Spondylitis Functional Index was a 10-item selfreported index that was developed to define and monitor physical function in patients with AS using the visual analog scale (VAS) [23] and Bath Ankylosing Spondylitis Metrology Index was developed to quantify the mobility of the axial skeleton in AS patients [24].Blood samples were obtained for measurement of; ESR, CRP, serum total cholesterol, HDL-C, triglycerides.…”